Healthy Moms, Happy Babies

Transcription

Healthy Moms,
Happy Babies:
A Train the Trainers Curriculum on
Domestic Violence, Reproductive
Coercion and Children Exposed
By Linda Chamberlain, PhD, MPH
and Rebecca Levenson, MA
PRODUCED BY
Futures Without Violence, formerly Family Violence Prevention Fund
FUNDED BY
Administration for Children and Families, U.S. Department of Health and Human Services and
Office on Women’s Health, U.S. Department of Health and Human Services
With Special Thanks to:
Marylouise Kelley, PhD
Director, Family Violence Prevention & Services Program
Family and Youth Services Bureau
Administration for Children and Families, U.S. DHHS
Frances E. Ashe-Goins, RN, MPH
Acting Director
Office on Women’s Health, U.S. DHHS
Aleisha Langhorne, MPH, MHSA
Health Scientist Administrator
Office on Women’s Health, U.S. DHHS
Futures Without Violence Wishes to Especially
Thank the Following Experts for their Contributions:
Jacquelyn C. Campbell, PhD, RN, FAAN
Anna D. Wolf Chair and Professor
School of Nursing, Johns Hopkins University
Linda F. C. Bullock, PhD, RN, FAAN
Jeanette Lancaster Alumni Professorship in Nursing
PhD Program Director
School of Nursing, Johns Hopkins University
Elizabeth Miller, MD, PhD
Chief, Division of Adolescent Medicine
Children’s Hospital Pittsburgh, University of Pittsburgh
and special thanks to Kristen Kaeding from Futures Without Violence for her work on this project.
INTRODUCTION
The Affordable Care Act, passed in 2010, included provisions to support America’s Healthy Futures Act. This act is a $1.5 billion dollar, five-year national initiative to support maternal infant
and early childhood home visitation programs. In addition to providing funds to support these
services, the legislation also included new benchmark requirements for states. One such benchmark requires home visitation programs to measure a reduction in “crime or domestic violence.”
This curriculum has been developed to help your home visitation program meet the federal
benchmark to address domestic violence.
Futures Without Violence, formerly Family Violence Prevention Fund, has been working with
home visitation programs and providing domestic violence training and education for more than
a decade. In response to the new federal benchmarks, Healthy Moms, Happy Babies: A Train
the Trainers Curriculum was created to support state agencies and home visitation programs in
developing a core competency strategy and to ensure that all home visitors have training and
resources to help women and children living in homes with domestic violence.
The curriculum provides training, tools, and resources to help home visitation staff address the
complex and sometimes uncomfortable issue of domestic violence. When it comes to promoting health and safety outcomes for women and children impacted by domestic violence, there
is a methodology to effective assessment, primary prevention, and anticipatory guidance messaging during home visits. What one says and how it is said—whether by direct assessment or
through universal education—matters and can make a difference for women and children living
with domestic violence. First, home visitation professionals need education about the impact
of violence on families. They also require tools to support assessment and conversations about
domestic violence. This curriculum provides simple tools to support assessment and education
through the use of scripts and safety cards during home visits. These tools have been designed
to facilitate safety planning and supported referrals to domestic violence programs.
Futures Without Violence is committed to further developing policy and public health responses
to domestic violence and reproductive coercion. One of our current initiatives is a multi-state and
Indian health initiative called Project Connect: A Coordinated Public Health Initiative to Prevent
Violence Against Women. Since 2010, states and tribes participating in Project Connect have
piloted the Healthy Moms, Healthy Babies curriculum and resources. Supported by the Office
on Women’s Health, U.S. Department of Health and Human Services, Project Connect and the
development of this innovative, research-based curriculum has been made possible through funding from the Violence Against Women and the Department of Justice Reauthorization Act of 2005
with additional funding from the Administration for Children and Families. Our hope is that every
home visitation program will integrate this curriculum into their core training and programming to
support safe and healthy families, and create futures without violence.
Linda Chamberlain, PhD, MPH Rebecca Levenson, MA
Consultant
Senior Policy Analyst
www.drlindachamberlain.com Futures Without Violence
I
Author Biographies
Dr. Linda Chamberlain, an epidemiologist specializing in the health effects of domestic violence
on women and children, is the founding director of the Alaska Family Violence Prevention
Project and a consultant for Futures Without Violence.
Rebecca Levenson, is Senior Policy Analyst at Futures Without Violence. A nationally recognized
speaker, she has worked extensively in the area of reproductive and perinatal health within
community clinics and home visitation programs for the past 20 years.
About the National Health Resource Center on Domestic Violence
For more than two decades, the National Health Resource Center on Domestic Violence has
supported health care practitioners, administrators and systems, domestic violence experts,
survivors, and policy makers at all levels as they improve health care’s response to domestic
violence. A project of Futures Without Violence, and funded by the U.S. Department of Health
and Human Services, the Center supports leaders in the field through groundbreaking model
professional, education and response programs, cutting-edge advocacy and sophisticated
technical assistance. The Center offers a wealth of free culturally competent materials that are
appropriate for a variety of public and private health professions, settings and departments.
For free technical assistance, and educational materials:
Visit: www.futureswithoutviolence.org/health
Call toll-free (Monday-Friday; 9am-5pm PST):
888-Rx-ABUSE (888-792-2873)
TTY: 800-595-4889
Email: [email protected]
II
TABLE OF CONTENTS
How to Use These Training Resources
Learning Objectives
Sample Agenda for One-Day Training
Module 1: Introduction and Workshop Guidelines (slides 1-12)
Module 2: Overview of Domestic Violence: Definitions and Dynamics (slides 13-23)
Module 3: Assessment and Safety Planning for Domestic Violence in Home Visitation
(slides 24-49)
Module 4: Impact of Domestic Violence on Perinatal Health Outcomes (slides 50-61)
Module 5: Making the Connection: Domestic and Sexual Violence, Birth Control
Sabotage, Pregnancy Pressure, and Unintended Pregnancy (slides 62-82)
Module 6: The Effects of Domestic Violence on Children (slides 83-90)
Module 7: Impact of Domestic Violence on Mothering: Helping Moms Promote
Resiliency for Children (slides 91-107)
Module 8: Childhood Exposure to Domestic Violence and Its Impact on Parenting
(slides 108-117)
Module 9: Fathering After Violence (slides 118-124)
Module 10: Preparing Your Program and Supporting Staff Exposed to Violence and
Trauma (slides 125-131)
Module 11: Mandated Reporting for Child Abuse: Challenges and Considerations
(slides 132-137)
Module 12: Closing and Post-training Survey (slides 138-141)
Appendices
A. Pre-training Survey
B. Power and Control Wheel Handout
C. Cultural Competency Case Study
D. Example of the Healthy Moms, Happy Babies Safety Cards (English and Spanish)
E. Relationship Assessment Tool
F. Safety Plan and Instructions
G. Sample Memorandum of Understanding
III
H. Example of the Loving Parents, Loving Kids Safety Cards (English and Spanish)
I. Birth Control Education Handout
J. Secondary Trauma Handout
K. Post-training Survey
L. DVDs
a. Addressing Domestic Violence in Home Visitation Programs:
A Video Training Series
i. Amber: Home Visitation Visit – Screening for Domestic Violence using the
Relationship Assessment Tool
ii. Marta: Home Visitation Visit – Assessment for Post Partum Depression and
Domestic Violence
iii. Desiree: Home Visitation Visit (Part 1): Partnering with Local Domestic
Violence Agencies
iv. Desiree: Home Visitation Visit (Part 2): Connecting the Impact of Violence
on Children’s Health and DV
v. Ms. Macon, Tiffany, and Richie: Home Visitation and the Impact of
Childhood Exposure to Violence on Parenting
b. First Impressions
c. Something My Father Would Do
Bibliography
IV
HOW TO USE THIS
TRAINERS CURRICULUM
This curriculum has been designed for home visitation programs and is focused on developing
staff skills and broadening staff’s thinking through interactive exercises and activities.
While this curriculum has been designed so that other trainers can use these
resources to conduct training independently, Futures Without Violence staff are
available for direct training and technical assistance to model how to use this
curriculum and how to develop a plan for sustainability and quality improvement
for enhanced domestic violence programming within home visitation and case
management programs.
!
The curriculum includes:
• Overview of how to use the PowerPoint slides, instructions for training, exercises, and directions for small group activities
• Companion CD/DVDs, which include participant handouts, assessment tools, and video clips
For those who have not used PowerPoint previously, as you look at the modules in the curriculum, each page shows both the PowerPoint slide view (top half of the page) and the Notes Page
view (bottom half of the page). Speakers’ notes for slides are provided in the Notes Page view
of PowerPoint. Information provided in the Notes Page view includes: how to facilitate discussion of the data/information reviewed in the slide; how to incorporate the exercises to support
participant learning; and guidelines for how to use the tools and handouts during the training.
If you have not used the Notes Page view in PowerPoint before, it can be accessed by selecting
the tab called “View” across the top of your computer screen and then selecting the “Notes
Page” option. This means that you can access the speakers’ notes during your presentation or
while you are preparing for a presentation by changing the view on your screen in PowerPoint.
Participants receiving this training should have a basic understanding of domestic violence. However, there is considerable variability among home visitation programs in terms of how much
training staff have received. Domestic violence advocates at local shelters and advocacy programs are an excellent resource to contact for domestic violence training and information.
If your audience has not had domestic violence training before or would benefit from a basic
overview of domestic violence, then you should include the second module of this presentation:
Overview of Domestic Violence: Definitions and Dynamics.
Each topic in this curriculum is a separate module so that you can include all of the content or
delete some modules based on the training needs of your audience and the time available for
the training.
V
There are several factors that will influence the length of your training when you use these
slides. Factors include:
• Whether you include all of the modules
• If you adjust the time allowed for interactive activities
• How much time you allow for questions and answers
• The amount of local/regional data and information that you add to your presentation
Intended audience:
• This curriculum was designed for home visitors, perinatal case managers, community outreach workers, program managers and agencies that sponser home visitation programs.
Time needed for training modules:
• If all of the training modules are used, this is an all-day training.
• Consider working with another trainer as a team. Ideally this team would include a domestic
violence advocate and a home visitor.
• The curriculum is designed to be flexible. Each module can be used separately so it is possible to do a series of trainings.
• Each module has its own learning objectives. The modules vary in length depending on the topic.
• Modules include discussion questions and/or activities which will influence the length of the
training depending on how much time is allowed for these interactive components. While
estimated times are provided for discussions and activities, these times could be extended
so that the training event is more than one day in length.
!
Trainer’s tip: There are many variables that influence the length of the training including the familiarity of the trainer with the material, the size of the audience, and the time
allowed for discussion and activities. Consider doing a practice training with co-workers to
become familiar with the content and conduct the activities in this curriculum. We strongly
recommend that you keep the interactive activity in place for optimal adult learning.
Materials needed to conduct training:
(Many of these resources may be downloaded at www.FuturesWithoutViolence.org or ordered
from our online catalog for a small shipping and handling fee.)
• Trainer’s Curriculum and PowerPoint slides
• DVD: Addressing Domestic Violence In Home Visitation Programs: A Video Training Series
• DVD: First Impressions
• DVD: Something My Father Would Do
• “Healthy Moms, Happy Babies” Safety Cards (available at www.FuturesWithoutViolence.org)
• “Loving Parents, Loving Kids” Safety Cards (available at www.FuturesWithoutViolence.org)
• PowerPoint set-up: laptop with DVD player or laptop and external DVD player, LCD projector,
screen to project image onto, power cords, and extension cords if needed
VI
• External speakers for playing DVDs (this is very important to have so that your audience can
hear the content of the video clips and DVDs)
• Flip-chart with stand and markers
• Masking tape to tape completed flip-chart sheets around the room
• Copies of handouts including the Pre- and Post-training Surveys and PowerPoint slides
(select the option for “handouts” and “slides per page: 6” as the options under “print what”
when printing your PowerPoint handouts)
• All participants should have a pen or pencil and a few sheets of note paper
Technical Skills for Trainers:
If trainers are not already comfortable using PowerPoint,
trainers will need to become familiar and comfortable
with this in order to provide training. A copy of the
PowerPoint presentation can be downloaded at www.
FuturesWithoutViolence.org. It is always important to be
prepared for possible equipment issues such as getting
your computer to mesh with a LCD projector so test the
equipment ahead of time. Also, consider having a back-up
projector and/or an extra bulb for the projector available
during the training.
Trainer’s Tip: Review the
notes before the training
and add tabs or markers for
information in the notes
that you want to highlight
during the training.
!
How This Trainer’s Curriculum is Organized:
Each training module comprises a separate section in this guide which includes:
• Estimated time
• Learning objectives
• Training outline (description of each slide)
• Overview
• Instructions for exercises and activities
• References for studies (in alphabetical order by author’s last name by module)
• Resources
Important notes for Trainers:
• Due to the high prevalence of domestic violence and reproductive coercion among women
in the general population, many participants may have had direct or indirect experiences
with abuse.
• This type of training can trigger painful memories and feelings for participants. Talking about
domestic violence, reproductive coercion, and the effects of violence on children are sensitive topics that can be emotional regardless of whether a person has had any direct experiences with abuse.
• Invite domestic violence advocates from your local/regional domestic violence program/
shelter to participate in the training. They can provide the latest information on resources,
contact information, and invaluable insights into the topics being discussed. Including
VII
domestic violence advocates in your training can help to build partnerships between home
visitors and local domestic violence service providers.
• It is also advisable, whenever possible, to have a domestic violence advocate available during this type of training to talk to any participants who need additional support. If this is not
possible, have the number of a local/regional DV program available during the training.
• Remember to be watchful of participants’ reactions to the content of this training. Check-in
during breaks with any participant that you think may be having difficulties during the training. Give extra breaks as needed, consider turning the lights down if someone is struggling
with emotions, give participants an opportunity to debrief, and incorporate breathing and
stretching exercises to reduce stress.
Training Site:
• Visit the location for the training ahead of time to determine equipment needs and considerations such as where the projector and laptop will be located, tables/carts for the projector
and laptop, if extension cords are needed and what type, where the screen will go, etc.
• Whenever possible, round-tables are recommended versus traditional classroom seating to
facilitate group work and discussion.
• Assess parking options, places to eat if lunch is not provided, and any information that you
need to share with participants prior to the training.
• Provide refreshments if possible.
!
VIII
Trainer’s Tip: To find more information about a study that has been referenced in a slide, go
to www.ncbi.nlm.nih.gov/pubmed/ or use a search engine for the term “pub med”. Once
you are in Pub Med, you can enter the author’s name and a word or two from the title of the
publication to obtain a listing of publications for that author. Once you have identified the
publication you are looking for, you can click on that title to access and print an abstract for
that article at no cost. If you want to purchase the article, that information is often provided.
Journal publications can also be accessed and copied at medical and university libraries.
LEARNING OBJECTIVES
As a result of this training, home visitors will:
1. Become more aware of the effects of domestic violence on women, children, and families.
2. Explain how domestic violence can interfere with the goals of home visitation programs.
3. Describe the role of the home visitor in assisting with safety planning and providing
supported referrals to domestic violence programs for clients who are experiencing
domestic violence.
4. Identify strategies to integrate self-assessment tools into routine screening for domestic
violence during home visits.
5. Demonstrate how to use safety cards to facilitate safety planning with families experiencing domestic violence.
6. Recognize the role of reproductive coercion in unintended pregnancies and rapid, repeat
pregnancies and its impact on the goals of home visitation services.
7. Describe how lifetime exposure to violence can affect parenting and the resiliency of
mothers who experience victimization.
8. Become more comfortable with identifying and addressing domestic violence and reproductive coercion with families.
9. Demonstrate competency in educating parents about how their childhood experiences of
victimization can be triggered or re-experienced and where to turn for help and support.
10. Increase personal safety and self-care strategies to reduce the potential danger and stress
of working with families experiencing domestic violence.
Please note that each training module begins with learning objectives that are also
included at the start of each training module in this curriculum.
IX
Sample Agenda for One-Day
Training Using All Modules
8:15-8:40 am
Introduction, Workshop Guidelines, and Pre-Training Survey
8:40-9:10 am
Overview of Domestic Violence: Definitions and Dynamics*
9:10-10:25 am Assessment and Safety Planning for Domestic Violence in Home Visitation 10:25-10:40 am
BREAK
10:40-11:00 am Impact of Domestic Violence on Perinatal Health Outcomes
11:00-12:05 pm
Making the Connection: Domestic and Sexual Violence, Birth Control
Sabotage, Pregnancy Pressure, and Unintended Pregnancy
12:05-1:00 pm LUNCH
1:00-1:45 pm The Effects of Domestic Violence on Children
1:45-2:15 pm Impact of Domestic Violence on Mothering: Helping Moms Promote
Resiliency for Children 2:15-3:00 pm Childhood Exposure to Domestic Violence and Its Impact on Parenting
3:00-3:10 pm BREAK
3:10-3:40 pm
Fathering After Violence**
3:40-4:00 pmPreparing Your Program and Supporting Staff Exposed to Violence and
Trauma
4:00-4:20 pm Mandated Reporting for Child Abuse: Challenges and Considerations
4:20-4:30 pm
Closing and Post-Training Survey * This is an optional module and the length varies significantly depending on the activities you
include
** This is also an optional module, and if you decide not to cover this section, you can add more
time for discussion in other sessions
X
Module 1: Introduction and
Workshop Guidelines
Module 1
Estimated Module Time: 25 minutes
Training Outline
• Workshop guidelines
• Pre-training survey
• Review the importance of addressing domestic violence (DV) in home visitation
programs
• Next steps to get started
Overview
The purpose of this module is to help the learner understand how screening for DV or
intimate partner violence (IPV) can make a difference in the lives of women and children.
The module makes the case for home visitors—showing how DV is connected to many
other home visitation program outcome goals, and most importantly, demonstrates how
talking with health care providers and home visitors increases the likelihood that women
are safer and more likely to seek domestic violence advocacy services.
Encourage participants to do what they need to feel safe and comfortable throughout
the training such as leaving the room and taking unscheduled breaks. They may also
approach one of the trainers at breaks or lunch to talk about issues. As a trainer, you
should anticipate that survivors will come forward and want to talk you, or an advocate
for support.
Remain aware of anyone who may be reacting to or be affected by the content of the
training. A good example of this is the DVD, First Impressions, which is used in the
module on “The Effects of Domestic Violence on Children,” which sometimes brings
up strong emotions. Consider giving extra breaks after particularly sensitive material,
or when you observe that someone is having a difficult time. Connect with that person
during the break to check-in and ask if he or she would like to talk with someone and
determine how follow-up can occur.
Module 1
Notes to Trainer: It is very helpful to have a domestic violence advocate present or on
call when you are doing a training on domestic violence. This type of training can trigger
painful memories while also creating the opportunity for survivors to process their feelings
and experiences.
Module 1
Estimated Activity Time: 5 minutes
Hand-out the pre-training survey for participants to complete and advise them that they
will be asked to do a post-training survey at the end of the training. Allow approximately
five minutes for participants to complete the survey. Advise participants that they do not
need to put their names on the surveys and that their responses are confidential.
Ask participants to follow the directions below. Advise them that they do not have to
share what they draw/write.
1. Take out a sheet of paper and draw a line with the words “not at all comfortable” on
the far left side of their line and the words “very comfortable” on the far right side of
their line.
2. Ask participants to take a minute to think about their comfort level right now with
talking to clients about domestic violence—and if he or she feels comfortable asking
questions and getting a “yes” as the answer.
3. Discuss how the goal at the end of today’s session is that each person has personally
moved that needle towards the ‘totally comfortable’ end of the scale.
4. Advise participants that this exercise will be repeated at the end of today’s session and
that you will ask them to consider whether the needle moved as a result of the training,
where it moved, and their thinking about this in the context of what they have learned.
The “Where Am I?” exercise is followed by small group discussion (see next slide) to
help participants identify and share why it is important for home visitors to know about
domestic violence.
Module 1
Estimated Activity Time: 2-3 minutes
Module 1
1. Ask participants to discuss this question for five minutes, breaking up into small
groups, if feasible. Instruct groups to prepare a brief answer, consisting of two sentences.
2. Ask each group to share their answers.
3. Go to the next slide which describes how domestic violence is connected to the goals
of many programs that provide home visitation services.
Module 1
Notes to Trainer: These are common goals among many home visitation programs.
There is an extensive body of research that has shown how domestic violence is connected to each of these outcomes. These connections will be described in this training.
Module 1
Notes to Trainer: This section closes with a review of the research that has shown
that just having the opportunity to talk to a home visitor or health care provider about
domestic violence can increase access to domestic violence services. Examples are also
provided for home visitation programs that have had significant impact on domestic
violence.
In this study by McCloskey et al. (2006), 132 women outpatients who disclosed domestic violence in the preceding year were recruited from multiple hospital departments
and community agencies. Abused women who talked with their health care providers
about the abuse were more likely to use an intervention and exit the abusive relationship. Women who were no longer with their abuser reported better physical health than
women who stayed.
McCloskey LA, Lichter E, Williams C, Gerber M, Wittenberg E, Ganz M. Assessing Intimate Partner Violence in
Health Care Settings Leads to Women’s Receipt of Interventions and Improved Health. Public Health Reporter.
2006;121(4):435-444.
At the time of this study, domestic violence was not routinely assessed or addressed as
part of the Nurse Family Partnership (NFP) home visitation model.
It is important to note that NFP has an excellent protocol for dealing with abuse when it
comes up and routinely asks about DV at visit one. However, NFP does not routinely ask
at other points during visitation. NFP does ask nurse home visitors to inquire further if
they see signs.
Olds DL, Robinson J, Pettitt L, Luckey DW, Holmberg J, Ng RK, Isacks K, Sheff K, Henderson CR. Effects of Home Visits by
Paraprofessionals and by Nurses: Age 4 Follow-up Results of a Randomized Trial. Pediatrics. 2004;114(6):1560-1568.
Module 1
The study population was primarily unmarried Mexican American and white pregnant
women.
Module 1
In a 15-year follow-up of the Nurse Family Partnership model, a home visitation program
that has been shown to reduce child maltreatment, the treatment effect of home visits
on reducing verified child abuse maltreatment reports decreased as the frequency of DV
increased.
Eckenrode J, Ganzel B, Henderson C, Smith E, Olds D, Powers J, Cole R, Kitzman H, Sidora K. (2000) Preventing Child
Abuse and Neglect with a Program of Nurse Home Visitation: The Limiting Effects of Domestic Violence. Journal of the
American Medical Association. 284(11): 1385-1391.
These barriers were identified during the implementation of the DOVE project which is
described as a promising practice in this chapter. Described as a “Town and Gown” partnership, a university partnered with home visitation programs in several counties. The
home visitors who participated in the qualitative study about barriers and facilitators
to addressing DV during home visits were a combination of nurses, social workers, and
unlicensed home visitors.
Eddy T, Kilburn E, Chang C, Bullock L, Sharps P. Facilitators and Barriers for Implementing Home Visit Interventions to
Address Intimate Partner Violence: Town and Gown Partnerships. Nursing Clinics of North America. 2008;43:419-435.
Module 1
Notes to Trainer: This Train the Trainer curriculum is designed to address the barriers
uncovered in this study.
Module 1
The brochure-based, empowerment intervention described in the Eddy study is modeled
after the empowerment intervention by McFarlane & Parker (1994) which was developed
from the Dutton (1992) empowerment model. McFarlane and Parker have evaluated this
brief intervention, which allows a woman to share her story and provides information on
the cycle of violence, community resources, and safety planning in several studies including an 18-month clinical trial (McFarlane et al, 2002, 2004; Parker et al, 1999). The empowerment model, which takes approximately 20 minutes, is also featured in the “March
of Dimes’ Protocol for Prevention and Intervention, 3rd Edition” (2007).
For more information about the DOVE program, contact Phyllis Sharps at [email protected]
Dutton M. Empowering and Healing the Battered Woman. 1992. Springer, New York, NY
Eddy T, Kilburn E, Chang C, Bullock L, Sharps P. Facilitators and Barriers for Implementing Home Visit Interventions to
Address Intimate Partner Violence: Town and Gown Partnerships. Nursing Clinics of North America. 2008;43:419-435.
March of Dimes. Abuse During Pregnancy: A Protocol for Prevention and Intervention, 3rd Edition. 2007. White Plains,
NY. www.marchofdimes.com/nursing
McFarlane J, Malecha A, Gist J, Watson K, Batten E, Hall I, Smith S. An intervention to increase safety behaviors of
abused women: results of a randomized clinical trial. Nursing Research. 2002;51:347-354.
McFarlane J, Malecha A, Gist J, Watson K, Batten E, Hall I, Smith S. A nursing intervention to increase safety behaviors
of abused women that remains effective for 18 months. American Journal of Nursing. 2004;104(3):40-50.
Parker B, McFarlane J, Soeken K, Sliva C, Reel S. Testing an intervention to prevent further abuse to pregnant women.
Research in Nursing and Health. 1999;22:59-66.
Home visitors may observe a wide range of environmental clues indicating that domestic
violence may be present including damaged furniture, doors, and/or walls; high levels of
tension in the home; rigid family roles; mistrust of outsiders; high levels of anxiety exhibited by the mother and/or children; and violent acting-out by children.
Evanson, T. (2006). Addressing Domestic Violence Through Maternal-Child Health Home Visiting: What We Do and Do
Not Know . Journal of Community Health Nursing 23:2, 95-111
Landenburger, Campbell, & Rodriquez. 2004 [Textbook: Family Violence and Nursing Practice, J. Humphreys & J. Campbell, Eds]
Module 1
Notes to Trainer: You may want to read the next sentence aloud.
Module 2: Overview of Domestic
Violence: Definitions
and Dynamics
(Depending on the amount of
discussion time and activities)
This module is recommended if your audience has not had previous training on domestic
violence or would benefit from an overview of introductory content on domestic violence. Recommend that participants contact their local domestic violence advocates for
more in-depth, comprehensive training on domestic violence.
Training Outline •
•
•
•
Learning objectives
Magnitude of problem, definitions, and key concepts
Culture and domestic violence
Validation and supportive messages
Overview The module begins with statistics about how common domestic violence is. This is followed by several key definitions and a handout of the Power and Control Wheel to help
participants recognize the many different forms of abuse that can occur within intimate
relationships.
Notes to Trainer: Read the learning objectives aloud.
Module 2
Due to how common domestic violence is, an estimated 15.5 million children live in
households where domestic violence has occurred within the past year.
Black MC, Breiding MJ, National Center for Injury Prevention and Control, CDC. Adverse Health Conditions and Health
Risk Behaviors Associated with Intimate Partner Violence---United States, 2005. MMWR. 2008;57(05):113-117.
Module 2
Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating Violence Against Adolescent Girls and Associated Substance Use,
Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. JAMA. 2001;286(5)572-579.
Sharps and colleagues identified eight studies that assessed DV and used home visitation during the perinatal period. All of the studies are described in a detailed table in the
publication by Sharps et al. (2008).
Sharps PW, Campbell J, Baty ML, Walker KS, Bair MH. Merritt Current Evidence on Perinatal Home Visiting and Intimate Partner Violence. J Obstet Gynecol Neonatal Nurs. 2008; 37 (4): 480-491.
Module 2
The considerable variation in estimates of prevalence among home-visited perinatal clients is influenced by many factors including whether assessment was routinely
implemented, how often the questions were asked, what type of questions/assessment tool was used and how the questions were asked, whether home visitors received training on screening and their comfort level with screening, and differences in
the study populations.
Module 2
Notes to Trainer: Advise participants that a definition of reproductive coercion will be
provided during this presentation.
Notes to Trainer: This is the definition of domestic violence.
Module 2
(a quick question and answer for the audience)
Module 2
Notes to Trainer: Remind the audience that we are focusing on teens and adults who are
experiencing abusive behaviors that are perpetrated by their intimate partners. There
would be other reasons and circumstances if we were talking about children who were
being physically or sexually abused by a parent or another adult.
Reasons why women stay:
• Because she loves him and has hope that he will change
• Lack of safe option for herself and children
• Lack of family or community support/Lack of money or loss of status
• Women do leave—but leaving is a process
• In some cases, the violence does end
Notes to Trainer: Provide the Power and Control Wheel handout and allow participants
a moment or two to review the handout.
For more information on the Wheel go to: www.theduluthmodel.org
A handout on the Power and Control Wheel is available in Appendix B
Module 2
Notes to Trainer: Every culture has elements that condone men’s controlling behavior of women
and some line differentiating what level of abuse is considered acceptable. For example, under
certain circumstances, minor violence such as pushing or shoving might be condoned, while
abuse beyond that level is considered unacceptable.
Module 2
Shelter from the Storm, a curriculum for mental health clinicians who work with children exposed to domestic violence, raises the point that ethnic/cultural background may influence any
of the following factors when domestic violence is present:
•
•
•
•
•
•
The batterer’s tactics
The survivor’s coping strategies
Community response
Institutional response
The individual meaning of violence
The quality of the service provider-client relationships
Anyone can be a victim of domestic violence regardless of: age, race, ethnicity, sexual orientation, religion, class, immigration status, disability, region (rural/urban).
Some studies show that African American, Native American, and Latina women experience
higher rates of domestic violence while others find that when socioeconomic status is accounted
for ethnic differences are reduced or eliminated.
Mitchell SJ, See HM, Tarkow AKH, Cabrera N. Conducting Studies with Fathers: Challenges and
Opportunities Applied Development Science 2007, Vol. 11, No. 4, 239-244.
Tjaden P, Thoennes N. Extent, Nature, and Consequences of Intimate Partner Violence. U.S.
Department of Justice, Offices of Justice Programs, National Institute of Justice. Washington, DC.
July, 2000.
Notes to Trainer: Distribute the case study on cultural competency and ask participants
to read the definitions and scenario (provide a few minutes to do this). Ask the group
the following questions:
Question #1: Focusing on cultural and linguistic competency, what concerns do you have about how the home visitor responded to this client’s concerns?
The client’s concern that her husband would be angry raises significant concerns about domestic violence and/or
reproductive coercion. Using the client’s husband or any family member as an interpreter could be dangerous. The
husband may retaliate against the client. Other family members may not keep the information confidential or may
confront the husband which could lead to retaliation against the client.
Question #2: What would be a safer approach for this client?
Use a trained interpreter (in-person or by phone) who understands Dominican culture, language, and domestic violence to discuss the following concerns with the client:
•
Ask the client if she is being hurt or threatened by her partner and if her partner is interfering with her ability to
make choices about her reproductive health, such as using condoms.
•
Discuss with the client what may be the safest option to notify her husband that he needs treatment for the
sexually transmitted infection.
•
Provide information about sexually transmitted infections and treatment and a safety card that addresses domestic violence with hotline phone numbers and local resources in Spanish for the client to review and keep if it is
safe for her to do so.
Module 2
Concerns about using the client’s husband to interpret should be noted by participants. While the male is usually the
head of the household in Dominican culture and is often consulted about health-related decisions, in this situation,
the sensitivity of the client’s problem would indicate that using her husband as the interpreter is not appropriate.
There may also be religious considerations that may be a barrier to the client asking the husband to use condoms.
Notes to Trainer: Key points to cover in group discussion:
Module 2
• Goal is not to get her to leave (can be the most dangerous time for her)
• Identify the problem and support her by offering harm reduction strategies
• Connect her to an advocate for safety planning
Module 3: Assessment and
Safety Planning for
Domestic Violence in
Home Visitation
Module Time: 1 hour 15 minutes
Training Outline
•
•
•
•
•
•
•
•
Learning objectives
Group discussion exercise
Scripted assessment
Using the Healthy Moms, Happy Babies Safety Card
Using the Relationship Assessment Tool
Partnering with local domestic violence programs and advocates
Safety planning characteristics and defining success
Resources
Module 3
Overview Many home visitation programs struggle with domestic violence screening, referral and with
building partnerships with local domestic violence programs. Assessment strategies and
tools have been developed to integrate screening for domestic violence more comfortably
into home visitation programs. The new federal benchmarks for home visitation require
that programs document screening, and track referrals. This module will train home visitors
how to screen, refer and document these activities as part of routine programming.
Module 3
Notes to Trainer: Ask participants to take the first statement and just think about it for
a minute. Each person should take a second and ask themselves if this was ever true for
you—or true for a colleague?
Module 3
Ask participants: “When doing an assessment with one of your clients and working with
standardized forms you have to fill out, have you ever not asked a question the way it was
written on the form, or changed the order in which the question appeared?” Ask participants to raise their hands if they think it is a safe environment to share their thoughts. If
they are worried about getting in trouble with their supervisor they may remain silent.”
Question to pose to the audience: “Do you think this kind of deviation is a good or bad
thing?” Then ask about why participants (hypothetically if need be) might deviate from a
form—bringing it back to the statements on the slide.
Now let’s look at the second statement—do you think this is true?
Notes to Trainer: Taking the first statement, ask participants: What do you think? Does it
work? Why do you think they asked this way?
Answer: This assures that clients are clear that the home visitor is looking for a negative answer
(same is true of the second question, yes?).
A home visitor could ask any of the questions 1-5—asking any of them as they are would allow
someone to check their list that the DV screening or assessment was completed, but it may not
effectively identify women in violent relationships.
Discuss question 3 and 4. What are the problems with these questions?
Again this is someone looking to get a ‘no’ from the client, not a yes or positive disclosure of violence.
Question #5. Ask participants: What does this make you think of? Community violence, loose railings or floorboards, etc. This question isn’t direct enough to establish safety in the relationship.
Module 3
Answer: Using words like domestic violence or asking if someone is abused can be stigmatizing.
Also, women in abusive or controlling relationships may not think these words apply to them because what is happening isn’t bad enough. Many clients may imagine that women in violent relationships need to be acutely injured or hospitalized. Or they may say no to a screening question
because they don’t want the label of being abused—avoiding labels and describing behaviors.
Notes to Trainer: It is important to keep in mind fears about immigration status and child
welfare workers. This study overview may be interesting to read aloud to participants:
In a study by Renker & Tonkin (2006), 97% of women stated that they were not embarrassed, angry, or offended by their health care provider asking about domestic violence
during prenatal care visits.
Module 3
Renker P, Tonkin P. (2006) Women’s views of confidentiality issues related to and acceptability of prenatal violence
screening. Obstetrics and Gynecology, V.107 N.2, February, 2006: 348-354
Module 3
Estimated Activity Time: 2–3 minutes
Notes to Trainer: Hand out the safety card Healthy Moms, Happy Babies to audience.
This can be turned into a group discussion, quick debrief or small group activity.
Safety first! Never leave this card for the client without going over it with her—it may
put her at risk if her partner accidently finds it. After reviewing the card ask your client if
it is safe to leave the card.
Module 3
This card was developed with the clients safety in mind and modeled after the ‘shoe card’
that domestic violence advocates have used for years—making it easier for the client to hide.
To turn the card to a staff prompt you would just need to change the wording on the card
to make it an assessment tool. Example from the card: “Do I feel respected, cared for and
nurtured by my partner?” Can easily be changed to: “Do you feel respected, cared for and
nurtured by your partner?” This works with the other sections of the card as well.
Home visitors can introduce this card and say: “We started giving this card to all our
moms. It talks about healthy and safe relationships, it’s kind of like a magazine quiz…”
How else might you start the conversation about the card?
Take a minute to think about how you might introduce the card. Debrief ideas with
the group.
Notes to Trainer: This is the second panel of the safety card Healthy Moms, Happy
Babies.
Module 3
Note to Trainer: This section of the card reflects portions of the self-administered Relationship Assessment (see handout) and can be used as a way to introduce that tool.
“This section is similar to this questionnaire we are doing with all our moms, so why
don’t we take a minute and have you do that now?”
Module 3
What to do with a negative screen for domestic violence: “I’m glad nothing like this
is going on for you. Because many women are in unhealthy or abusive relationships,
we are giving this card to all our moms so you will know how to help a friend or family
member…”
Notes to Trainer: This section of the card highlights home visitation staff’s responsibility
to understand state reporting laws and lets clients know that they can turn to you for important information in this area. It may be useful to refer back to slide 28 and the study
done by Renker to highlight the importance of knowing and informing clients about
reporting laws. (For additional information on reporting issues please see Module 11 of
this curriculum).
Module 3
Module 3
Notes to Trainer: Once you have reviewed the card, next review the Relationship Questionnaire. The script at the top of the page is set up to be modified state by state—
please encourage participants to make the changes to this assessment tool before using
in the field. It may be necessary to read all the questions on the tool aloud to your client,
taking a moment to make sure they understand what is being read to them. “So let’s
go over this Relationship Assessment Tool together, here is how the scoring for each
question works. So for question #1 looking at this scale (read entire scale to client) what
number best reflects how you feel?”
“Everything you share with me today is confidential unless (NOTE: Participants must
double check state law and insert here—this may also include any reports to child welfare for witnessing domestic violence or mandatory reports to police for injury associated with domestic violence for adult women) you were to tell me that you are going to
hurt yourself, someone has hurt you with a weapon, or your children are being harmed.
Those things I would have to report, ok?”
Next train home visitors on how to offer support, safety planning and referral if a client
scores over 20 on the Relationship Questionnaire. Validate, do a safety plan and refer
her to domestic violence advocacy services.
AMA: Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Health literacy: report of the Council
on Scientific Affairs. JAMA. 1999;281: 552-557.
Module 3
Module 3
Notes to Trainer: Documentation of what you discussed is important. Using the
Relationship Assessment Tool, all you need to do is circle the options to record what
you have offered or given your client.
Every client should be given the Healthy Moms, Happy Babies card unless it is unsafe for
her to take it. Always double check to see if it is ok to leave the card with her.
IMPORTANT! The Healthy Moms, Happy Babies card should be given (unless it is unsafe
for her to take it) to all clients no matter whether their scores are high or low on the
Relationship Assessment Tool.
Some women will not be comfortable recording how bad things are in their relationship
and sharing that information with her home visitor, but can benefit from receiving the
information on the card.
Module 3
Module 3
Notes to Trainer: Getting to know your local DV program staff will help ensure that
each referral feels genuine and supportive to your clients.
Notes to Trainer: This is the section of the safety card you are referring to on the previous slide.
Module 3
Module 3
Notes to Trainer: Contact the nearest domestic violence shelter or the domestic violence coalition in your state to talk with domestic violence advocates and learn more
about safety planning, training, and resources for families who have experienced
violence in a relationship.
Estimated Activity Time: 10 minutes to watch video and
10 minutes for discussion
Discussion questions to ask after watching this video clip include:
1. Let’s start by discussing the opening of the video—what do you think about the way
the home visitor began the visit with mom?
2. How do you think the presentation of the Healthy Moms, Happy Babies card went? Did
it feel judgmental or supportive to you? The goal with this question is to get the audience to think about the way the card was introduced and how the home visitor suggests the card can be used for a friend or a family member.
4. What did you think about the situation shown between the two home visitors at the
end of the video? How many of you have an opportunity to debrief with colleagues
about difficult situations with your clients?
5. Any final thoughts about what you saw? Doable? Concerns?
Module 3
3. What do you think about the way that Lonna (Home Visitor) handled the way Amber
responded to the Relationship Assessment Tool? What did you like about it and what
would you change?
Module 3
Notes to Trainer: Many people think domestic violence programs provide only shelter beds. This panel of the card can help clients understand the range of services
available in their community.
Notes to Trainer: If there are not any local resources or you do not have information about local referrals, the National Domestic Violence Hotline can help.
Module 3
Module 3
Notes to Trainer: This is the panel of the safety card referred to in the previous slide.
Directions for Role Play
Divide participants into groups of three.
•
Advise participants that one person will role play the home visitor, one is the client and the third person is the
observer.
•
Advise the person who is role playing the home visitor to use the panel of the card to assess for a controlling relationship.
•
Read the scenario, as shown on the slide, aloud to participants: “Your client, Stephanie, is a 24-year-old mother
of four children. Using Healthy Moms, Happy Babies safety card, please review the first two panels of the card
(clients, please answer yes to at least one question from the On Bad Days? section of the Healthy Moms, Happy
Babies safety card) and follow the key steps you just learned to best help client with safety planning and referral.
•
Allow 10 minutes for the role play.
•
Ask participants who were the observers of the interaction to think about the kinds of things that the home visitor said that worked well, such as how did she/he introduce the card? Did she/he make the discussion comfortable? What would they have liked to see more of? Did the provider do safety planning with the client? How did
the home visitor handle describing the hotline numbers on the back of the card?
•
Ask the participants who role played the client how the assessment made them feel.
•
Ask participants who role played the home visitor if they were comfortable asking these questions. If some of the
home visitors indicated that they were not comfortable, ask what would help to increase their comfort level.
•
Ask participants who were the observers to share their thoughts and observations about what they liked and
thought would be helpful.
•
If there is enough time, you can ask groups to switch roles and do the role play again.
Module 3
•
Notes to Trainer:
• You do not need to be an expert in domestic violence to help women in your home
visitation program.
• Our job is not to “fix” domestic violence or to tell victims what to do.
• Providing support and information can make a difference in the lives of victims.
Module 3
• We can help victims by understanding their situation and recognizing how abuse can
impact health, risk behaviors and parenting.
Module 3
Module 3
Notes to Trainer: Some programs may consider getting training and certification to use
the danger assessment tool. Others programs may refer to DV programs who may use it
with clients.
Baker L, Cunningham A, Helping an Abused Woman: 101 Things to Know, Say and Do. 2008. www.lfcc.on.ca
Module 3
Module 4: Impact of Domestic
Violence on Perinatal
Health Outcomes
Module 4
Training Outline
• Learning objectives
• Large group discussion
• Effects of domestic violence around the time of pregnancy
Overview
Improving perinatal and birth outcomes are core goals for many home visitation programs. This module makes the connection between pregnancy and domestic violence
including associated risk behaviors around the time of pregnancy that are associated
with poor birth outcomes, low birth weight, interference with breastfeeding, and postpartum depression. By beginning with a large group discussion to identify these connections, participants demonstrate what they already know about domestic violence and
pregnancy through their work and life experiences.
Module 4
Module 4
Notes to Trainer: For this activity, you will need a flipchart and markers.
• Ask participants to call out responses to the question “How does domestic violence
impact women’s perinatal health and their birth outcomes?”
• Repeat participants’ responses, clarify as needed and give hints about what is missing. For example, if depression has not been mentioned the facilitator could ask , “So
let’s talk about how this might impact moms’ feelings or emotional health…”
• If you are working with another trainer, one of you should be the note-taker. The notetaker records what the participants call out onto the flipchart and then tapes sheets
when they are full around the room so the responses can be seen by the audience.
• When the trainer feels that some of the key effects have been identified, move
forward through the next slides in this module to review and highlight examples that
were given, as well as anything that was missing.
Pregnancy-associated homicides were analyzed with a national dataset (1991-1999)
from the Pregnancy Mortality Surveillance System at the Centers for Disease Control and
Prevention for this study.
Pregnancy-associated injury deaths and homicides were defined as women who died
during or within one year of pregnancy.
Of all pregnancy-associated injury deaths, motor vehicle accidents was the leading cause
(44.1%) and homicide was the second leading cause (31.0%). The rest of the pregnancyassociated injury deaths were attributed to unintentional injuries (12.7%), suicides
(10.3%), and other (2.0%).
Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: A Leading Cause of Injury Deaths Among Pregnancy and Postpartum Women in the United States, 1991-1999. American Journal of Public Health. 2005;95(3):471-477.
Module 4
Notes to Trainer: Inform participants that a majority of female homicides are women
who were murdered by a current or former intimate partner.
Module 4
Experiencing domestic violence around the time of pregnancy has been shown to be
associated with substance abuse, mental health problems, and other risk behaviors that
are associated with poor pregnancy outcomes.
Amaro H, Fried LE, Cabral H. Zuckerman B. Violence During Pregnancy and Substance Use. American Journal of Public
Health. 1990;80(5):575-579.
Bailey BA, Daugherty RA. Intimate Partner Violence During Pregnancy: Incidence and Associated Health Problems in a
Rural Population. Maternal and Child Health Journal. 2007;11(5):495-503.
Berenson AB, Wiemann CM, Wilkinson GS, Jones WA, Anderson GD. Perinatal Morbidity Associated with Violence
Experienced by Pregnant Women. American Journal of Obstetrics and Gynecology. 1994;170:1760-1769.
Campbell JC, Poland ML, Waller JB, Ager J. Correlates of Battering During Pregnancy. Research in Nursing and Health.
1992;15:219-226.
Curry MA. The Interrelationships Between Abuse, Substance Use, and Psychosocial Stress During Pregnancy. JOGNN.
1998;27(6):692-699.
Martin SL, Beaumont JL, Kupper LL. Substance Use Before and During Pregnancy: Links to Intimate Partner Violence.
American Journal of Drug and Alcohol Abuse. 2003;29:599-617.
Martin SL, Kilgallen B, Dee DL, Dawson S, Campbell JC. Women in Prenatal Care/Substance Abuse Treatment Programme: Links between Domestic Violence and Mental Health. Journal of Maternal and Child Health. 1998;2:85-94.
McFarlane J, Parker B. Soeken K. Physical Abuse, Smoking and Substance Abuse During Pregnancy: Prevalence, Interrelationships and Effects on Birth Weight. Journal of Obstetrics, Gynecology and Neonatal Nursing. 1996;25:313-20.
Perham-Hester KA, Gessner BD. Correlates of Drinking During the Third Trimester of Pregnancy in Alaska. Maternal
and Child Health Journal. 1997;1(3): 165-172.
Bullock LFC, Mears JLC, Woodcock C, Record R. Retrospective Study of the Association of Stress and Smoking During
Pregnancy in Rural Women. Addictive Behaviors. 2001;26:405-413.
Module 4
In this retrospective study by Bullock et al. (2001), rural postpartum women (n=293)
were interviewed during their hospital stay about their tobacco use and experiences
with DV. DV was measured with the Abuse Assessment Screen which includes questions
on physical, sexual, and emotional abuse within the past year and since pregnancy. The
rate of smoking among abused women during pregnancy is in agreement with other prospective studies that found between 44% and 60% of abused women continue to smoke
during pregnancy.
Module 4
In this study:
• Women were significantly more likely than men to experience physical or sexual
abuse and abuse of power and control by an intimate partner compared to men.
• Both physical and psychological abuse by an intimate partner were associated with
significant physical and mental health problems for male and female victims.
Coker AL, Smith PH, Thompson MP, McKeown RE, Bethea L, Davis KE. Social Support Protects Against the Negative Effects of Partner Violence on Mental Health. Journal of Women’s Health & Gender-Based Medicine. 2002;11(5):465-476.
Lipsky S, Holt VL, Esterling TR, Critchlow C. Police-Reported Intimate Partner Violence During Pregnancy and Risk of
Antenatal Hospitalization. Maternal and Child Health Journal. 2009;8(2):55-63.
Moraes CL, Amorim AR, Reichenheim ME. Gestational Weight Gain Differentials in the Presence of Intimate Partner
Violence. International Journal of Gynaecology and Obstetrics. 2006;95:254-260.
Silverman JG, Decker MR, Reed E, Raj A. Intimate Partner Violence Victimization Prior to and During Pregnancy Among
Women Residing in 26 U.S. States: Associations with Maternal and Neonatal Health. American Journal of Obstetrics
and Gynecology. 2006;195:140-148.
Sarkar NN. The Impact of Intimate Partner Violence on Women’s Reproductive Health and Pregnancy Outcome. Journal of Obstetrics and Gynaecology. 2008;28(3):266-271.
Module 4
Numerous studies have documented the impact of domestic violence on pregnancy. An
overview of the effects of domestic violence on women’s reproductive health and pregnancy can be found in a review study by Sarkar (2008).
Module 4
This study analyzed data from 26 U.S. states that participated in the 2000-2003 Pregnancy Risk Assessment Monitoring System (PRAMS).
Domestic violence (DV) was measured by two questions as follows:
• “During the 12 months before you got pregnant, did your husband or partner push,
hit, slap, kick, choke or physically hurt you in any other way?”
• “During your most recent pregnancy, did your husband or partner push, hit, slap,
kick, choke, or physically hurt you in any other way?”
Women who reported DV in the year prior to pregnancy but not during pregnancy,
women who reported DV during pregnancy but not in the year prior to pregnancy, and
women who reported DV during the year prior to pregnancy and during pregnancy were
significantly less likely to breastfeed their infants.
Silverman JG, Decker MR, Reed E, Raj A. Intimate Partner Violence Victimization Prior to and During Pregnancy Among
Women Residing in 26 U.S. States: Associations with Maternal and Neonatal Health. American Journal of Obstetrics
and Gynecology. 2006;195:140-148.
Blabey MH, Locke ER, Goldsmith YW, Perham-Hester KA. Experience of a Controlling or Threatening Partner Among
Mothers with Persistent Symptoms of Depression American Journal of Obstetrics & Gynecology. 2009;201:173.e1-9.
Module 4
This data is from the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS).
Women completed a survey within a few months after delivery and were then contacted
again approximately two years later.
Module 4
It is important to note that this card can be used in conjunction with substance abuse,
depression and tobacco cessation assessment tools.
Module 4
Notes to Trainer: Home visitors can reintroduce the card with a focus on this panel like
this: “You might remember this card I showed you before? I want to talk about this panel
today because we are going to be talking about depression and it helps connect some of
the ways people cope when they are in stressful relationships…”
Module 5: Making the
Connection: Domestic
and Sexual Violence,
Birth Control
Sabotage, Pregnancy
Pressure, and
Unintended
Pregnancies
Module 5
Training Outline •
•
•
•
•
Learning objectives
Definitions, statistics, and examples of reproductive coercion
Group discussion: birth control sabotage
Assessment for reproductive coercion and responding to disclosures
Role play (slide)
Overview As we have learned more about different forms of abusive and controlling behaviors that
are used by partners to maintain power and control in a relationship, patterns of behaviors that affect women’s reproductive health have been identified. These behaviors,
which are referred to as reproductive coercion, include forced sex, birth control sabotage, pregnancy pressure, and condom manipulation. Using a skills-based approach, this
module includes assessment questions, scripting, and information about birth control
options that may be less visible and more effective for clients whose partners are interfering with their birth control.
Module 5
Module 5
Sarkar conducted a literature review of publications from 2002 through 2008 on the impact of domestic violence on women’s reproductive health and pregnancy outcomes.
In a study by Goodwin et al (2000), women who had unintended pregnancies were 2.5
times more likely to experience physical abuse compared to women whose pregnancies
were intended.
Sarkar NN. The Impact of Intimate Partner Violence on Women’s Reproductive Health and Pregnancy Outcome. Journal of Obstetrics and Gynaecology. 2008;28(3):266-271.
Module 5
Goodwin MM, Gazmararian JA, Johnson CH, et al. Pregnancy Intendedness and physical abuse around the time of
pregnancy: Findings form the pregnancy risk assessment monitoring system, 1996-1997. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Maternal and Child Health Journal. 2000;4(2):85-92.
Module 5
In this study with teenage mothers (ages 12-18) who were recruited from a labor and
delivery unit at a university hospital, physical abuse by an intimate partner was defined
as being hit, slapped, kicked, or physically hurt enough to cause bleeding or having been
hit during an argument or while her partner was drunk or high.
The odds of repeat pregnancy was 1.9 times higher among teen mothers who were
physically abused by their partner within three months of delivery compared to nonabused teen mothers.
Raneri LG, Wiemann CM. Social Ecological Predictors of Repeat Adolescent Pregnancy. Perspectives on Sexual and
Reproductive Health. 2007;39(1):39-47.
This quotation is from a qualitative study by Miller et al. (2007) on male pregnancy-promoting behaviors and adolescent partner violence. The teen girl was parenting a baby
from a different relationship and the abusive relationship started shortly after she broke
up with her son’s father. She went to a teen clinic and started Depo-Provera injections
without her new partner’s knowledge.
Module 5
Miller E, Decker MR, Reed E, Raj A, Hathaway JE, Silverman JG. Male Partner Pregnancy-Promoting Behaviors and
Adolescent Partner Violence: Findings From a Qualitative Study with Adolescent Females. Ambulatory Pediatrics.
2007;7(5):360-366.
Module 5
Decker MR, Silverman JG, Raj A. Dating Violence and Sexually Transmitted Disease/HIV Testing and Diagnosis among
Adolescent Females. Pediatrics. 2005;116(2):e272-276.
This quotation is from a qualitative study by Miller et al. (2007) on male pregnancy-promoting
behaviors and adolescent partner violence. The teen girl was parenting a baby from a different
relationship and the abusive relationship started shortly after she broke up with her son’s father. She went to a teen clinic and started Depo-Provera injections without her new partner’s
knowledge.
Module 5
2007;7(5):360-366.
1. Ask participants to give some examples of birth control sabotage. Module 5
2. Proceed to the next slide which provides examples of birth control sabotage and
highlight any examples that were not identified by participants.
Qualitative and quantitative research have shown an association between birth control sabotage and domestic violence.
Fanslow et al. (2008) conducted interviews with a random sample of 2,790 women who had ever had sexual intercourse. Women who had ever experienced domestic violence were more likely to have had partners who refused to
use condoms or prevented women from using contraception compared to women who had not experienced domestic
violence (5.4% vs. 1.3%).
Campbell J, Pugh LD, Campbell D, Visscher M. The Influence of Abuse on Pregnancy Intention. Women’s Health Issues.
1995;5:214-223.
Coggins M, Bullock LF. The Wavering Line in the Sand: the Effects of Domestic Violence and Sexual Coercion. Issues in
Mental Health Nursing. 2003:24(6-7):723-738.
Fanslow J, Whitehead A, Silva M, Robinson E. Contraceptive Use and Associations with Intimate Partner Among a
Population-based Sample of New Zealand Women. Australian & New Zealand Journal of Obstetrics & Gynaecology.
2008;48(1):83-89.
Lang DL, Salazar LF, Wingood GM, DiClemente RJ, Mikhail I. Associations Between Recent Gender-based Violence and
Pregnancy, Sexually Transmitted Infections, Condom Use Practices, and Negotiation of Sexual Practices Among HIVPositive Women. Journal of Acquired Immune Deficiency Syndromes. 2007;46(2):216-221.
2007;7(5):360-366.
Wingood GM, DiClemente R. The effects of an Abusive Primary Partner on the Condom Use and Sexual Negotiation
Practices of African-American Women. Journal of Public Health. 1997;87:1016-1018.
Module 5
Miller et al (2007) conducted interviews with 53 sexually active adolescent females. One-quarter (26%) of participants
reported that their abusive male partners were actively trying to get them pregnant. Common tactics used by abusive
male partners included:
• Manipulating condom use
• Sabotaging birth control use
• Making explicit statements about wanting her to become pregnant
Module 5
In this study by Raphael (2005), 474 teen girls on Temporary Assistance to Needy Families completed written surveys. The teens were recruited from two state-funded Teen
Parent Services sites and two community-based health clinics. Seventy percent were between the ages of 15 and 17 at the time of the birth of their first infant (mean =18 years)
and 95% of the girls were African Americans. Almost half (43%) of the girls were involved
with males who were older by 4 or more years. Fifty-five percent disclosed domestic
violence in the past 12 months. Findings included:
• Two-thirds (66%) of teen dating violence victims experienced birth control sabotage
compared to 34% of non-abused teens
• 34% of teen dating violence victims reported work or school related sabotage compared to 7% of teens who did not experience dating violence but were sabotaged in
relation to work or school.
Raphael J. Teens Having Babies: The Unexplored Role of Domestic Violence. The Prevention Researcher. 2005;12(1):15-17.
Notes to Trainer: Please hand out the Loving Parent, Loving Kids safety cards to participants.
Advise participants that they can order the cards from Futures Without Violence
www.FuturesWithoutViolence.org (write the website on the flipchart). If you do not
have the cards available, then use this to discuss the safety card and give everyone
ample time to review it so that they can use that information in the role play.
Module 5
Review these sample assessment questions from the Loving Parents, Loving Kids safety
card and ask participants how well these questions would work with their clients and
their comfort level asking these questions.
Module 5
Notes to Trainer: Implanon is a 3-year implantable contraceptive (etonogestrel). It is a
progestin-only method and does not contain estrogen. Information about Implanon and
the IUD can be found on the handout “Birth Control Education Handout” (see next slide).
Notes to Trainer: Provide the handout Birth Control Education Handout and discuss two
or three examples that are listed on the handout including the information provided
about that example. Ask participants if they are familiar with the methods described
in the handout. If participants indicate that they are not familiar with these methods,
brainstorm about how they can learn more about them. For example, asking someone
from a local reproductive health clinic to come to talk to their program about these
methods and what is available locally.
Module 5
Module 5
Notes to Trainer: Review these intervention strategies from the Loving Parents, Loving
Kids safety card. Highlight the importance of having local reproductive health referrals to
support mothers experiencing reproductive coercion.
Notes to Trainer: This is a good example of where to reintroduce the Relationship Assessment Tool and have the client review it with you for any changes.
Module 5
• “I’m glad you talked to me about this today.”
• “I’m so sorry this happening in your life, you don’t deserve this.”
• “It’s not your fault.”
Module 5
• “I’m worried about the safety of you and your children.”
• “You deserve to be treated with respect.”
Estimated Activity Time: 10 minutes to watch video “Marta:
Home Visitation Visit – Assessment for Post Partum Depression
and Domestic Violence“ and 10 minutes for discussion.
2. What did not work well?
3. Were there some other questions that should have been asked? (Assessment for hurting the kids should have been included in the depression assessment for example.)
4. How could this approach to integrated assessment be adapted for home visits?
5. How many of you have ever called the hotline “just to see what it was like?” Was this
approach effective?
6. What kinds of examples did you see to help “normalize” the conversation?
Module 5
1. What do you think worked well?
Exercise Activity Time: 15 minutes
Directions for role play:
• Divide participants into groups of three.
• Advise participants that one person will role play the home visitor, one is the client, and the third
person is the observer.
• Advise the person who is role playing the home visitor to use the “Let’s Talk Pregnancy” panel of the
Module 5
card to assess for reproductive coercion.
• Read the scenario, as shown on the slide, aloud to participants:
“Your client is a 19 year old mother of a newborn infant and the discussion is about pregnancy
spacing. Using the Loving Parents, Loving Kids safety card, review the panel, “Let’s Talk Pregnancy,” and ask your client questions about her ability to negotiate unwanted sex, any experiences
with birth control sabotage, and her ability to negotiate pregnancy spacing.”
• Allow 3-5 minutes for the role play.
• Ask the observers to think about the kinds of things that the home visitor said that worked well such
as how did she/he introduce the card? Did she/he make the discussion comfortable? What would
they have liked to see more of?
• Ask the participants who role played the client how the assessment made them feel.
• Ask participants who role played home visitors if they were comfortable asking these questions. If
some of the home visitors indicated that they were not comfortable, ask what would help to increase
their comfort level.
• Ask the observers to share their thoughts and observations about what they liked and thought would
be helpful. • If there is enough time you can ask groups to switch roles and do the role play again.
Reproductive Health and Partner Violence Guidelines: An Integrated Response to Intimate Partner Violence and Reproductive Coercion focuses on the transformative role
of the reproductive health care provider in identifying and addressing intimate partner
violence (IPV) and reproductive coercion.
Available in hard copy or as a PDF from the Futures Without Violence online store.
To place orders, visit www.FuturesWithoutViolence.org/health
Module 5
Module 5
Resource: www.knowmoresaymore.org
Module 6: The Effects of
Domestic Violence
on Children
Training Outline
•
•
•
•
•
Learning objectives
Large group discussion on the effects of domestic violence on children
First Impressions DVD
Large group discussion on strategies to help children exposed to domestic violence
Resources
Overview
One of the important advances in the field of domestic violence has been research on how exposure to
violence affects children. Early trauma such as chronic exposure to domestic violence can lead to predictable physical, mental, behavioral, and cognitive problems for children.
There are also implications for early brain development, as described in the DVD, First Impressions. Major
advances in our understanding of early brain development explain why infants and younger children are
especially vulnerable to trauma. The good news is that strengthening children’s relationships with the nonbattering parent and other supportive caregivers such as home visitors are protective factors that can help
children cope with the stress of living in a home with domestic violence and heal from trauma.
Begin with a review of the learning objectives for this module. This is followed with a large group discussion on the effects of domestic violence on children. The goal for this large group discussion is for the audience’s expertise to be highlighted and for them to use their knowledge to educate others around them.
The following slides are for review purposes to note any effects that were not raised during the discussion.
Most likely, home visitors will identify a wide range of effects on children that go well beyond the content
of the slides.
Notes to Trainer: The goal for this large group discussion is for the audience’s expertise
to be highlighted—to use their knowledge to educate those around them. Ideally, two
people should work together to facilitate this section—one person guiding the discussion and one person recording participants responses on butcher paper, a blackboard, or
some other means of recording and sharing feedback.
Module 6
The facilitator asks the audience: “How does exposure to domestic violence affect
children?” The facilitator should be prepared to repeat what is said and clarify and
give hints about what is missing. For example, if anxiety and depression have not been
mentioned the facilitator could ask, “So let’s talk about how domestic violence might
make children feel…”
The note-taker records what the participants call out. It is helpful for the note-taker also
to repeat what is being said and clarify as needed as the responses are recorded.
When the facilitator feels that some of the key effects have been identified, the next
three slides on the effects of violence on children can be reviewed to highlight examples
that were given as well as anything that was missing.
Notes to Trainer: Many studies have shown that children who are exposed to violence
have more physical health problems and these problems may persist after the violence
has ended.
Campbell JC, Lewandowski LA. Mental and Physical Health Effects of Intimate Partner Violence on Women and Children. Psychiatric Clinics of North America. 1997;20(2):353-374.
Graham-Bermann SA, Seng J. Violence Exposure and Traumatic Stress Symptoms as Additional Predictors of Health
Problems in High-risk Children. Journal of Pediatrics. 2005;146(3):349-354.
Module 6
Children exposed to domestic violence are at much higher risk for mental health problems and have significantly higher usage of mental health services compared to children
who are not exposed to domestic violence.
Edelson J. Children’s Witnessing of Adult Domestic Violence. Journal of Interpersonal Violence. 1999;14:839-870.
Graham-Bermann SA, Levendosky AA. Traumatic Stress Symptoms in Children of Battered Women. Journal of Interpersonal Violence. 1998;13(1):111-128.
Hurt H, Malmud E, Brodsky NL, Giannetta J. Exposure to Violence: Psychological and Academic Correlates in Child Witnesses. Archives of Pediatric Adolescent Medicine. 2001;155:1351-1356.
Lehmann P. Posttraumatic Stress Disorder (PTSD) and Child Witnesses to Mother-Assault: A Summary and Review. Children and Youth Services Review. 2000;22(3/4):275-306.
McCloskey LA, Walker M. Posttraumatic Stress in Children Exposed to Family Violence and Single-Event Trauma. Journal of the American Academy of Child and Adolescent Psychiatry. 2000;39:108-115.
Module 6
Pfouts J, Schopler J, Henley H. Forgotten Victims of Family Violence. Social Work. 1982; July:367-368.
Spaccarelli S, Sandler IN, Roosa M. History of Spouse Violence Against Mother: Correlated Risks and Unique Effects in
Child Mental Health. Journal of Family Violence. 1994;9(1):79-98.
Wilden SR, Williamson WD, Wilson GS. Children of Battered Women: Developmental and Learning Profiles. Clinical
Pediatrics. 1991;30:299-304.
Wolfe DA, Crooks CV, Lee V, McIntyre-Smith A, Jaffe PG. The Effects of Children’s Exposure to Domestic Violence: A
Meta-Analysis and Critique. Clinical Child and Family Psychology Review. 2003; 6(3):171-187.
Exposure to domestic violence has significant consequences for children’s school performance.
Hurt H, Malmud E, Brodsky NL, Giannetta J. Exposure to Violence: Psychological and Academic Correlates in Child Witnesses. Archives of Pediatric Adolescent Medicine. 2001;155:1351-1356.
Kernic MA, Holt VL, Wolf ME, McKnight B, Hueber CE, Rivara FP. Academic and School Health Issues Among Children
Exposed to Maternal Intimate Partner Abuse. Archives of Pediatric and Adolescent Medicine. 2002;156:549-555.
Module 6
First Impressions is a DVD that is designed to educate adult caregivers and parents about
the effects of exposure to violence on children’s early brain development and their
health. The DVD is available on the curriclum CD/DVD and is frequently used in trainings
for service providers.
ACTIVITIES: First Impressions DVD and Large Group Discussion
• For this activity, you will need the First Impressions DVD, a DVD player and speakers.
First Impressions is found on the CD/DVD provided for this training.
Module 6
• Play the DVD ahead of the training to check the volume level for the speakers.
• First Impressions is approximately 15 minutes in length and is the first selection on
the menu (the DVD also includes short clips from the DVD). You also have the option
of playing the DVD in English or Spanish.
• After you have played First Impressions, ask participants to describe some strategies
they could offer to a mother to help her children when they have been exposed to
violence.
• Allow approximately 5 minutes for this group discussion; there is no note-taking for
this discussion.
Notes to Trainer: Some of the strategies that we heard in the First Impressions DVD from
parents who have experienced domestic violence and adult survivors who were exposed
to domestic violence as children are listed below:
• Ask children how they are feeling and validate their feelings
• Increase quality time of parents/caregivers with the child
• Reach out to other caregivers to help them understand the child’s situation and how
they can be supportive
• Create lots of opportunities for exploring and learning to promote healthy brain
development
Module 6
Module 7: Impact of
Domestic Violence on
Mothering: Helping
Moms Promote
Resiliency for Children
Module 7
Training Outline
•
•
•
•
Learning objectives
Information on the effects of violence on parenting
Past exposure to violence and resiliency
Strategies to strengthen mother-child bond
Overview
The impact of exposure to domestic violence goes beyond the health effects on women
and children—it also can diminish parenting skills. There are important findings on how
to build resiliency in the face of domestic violence and improve mother/child bonding.
This module covers multiple tools that home visitors can use to help mothers and children thrive.
Module 7
Module 7
Despite excellence in prenatal care, domestic violence was associated with poorer maternal attachment and assessment of infant temperament in this study.
Poor maternal-infant attachment is associated with several negative outcomes for children including behavioral problems, aggression, and poorer social interaction.
Quinlivan JA, Evans SF. Impact of Domestic Violence and Drug Abuse in Pregnancy on Maternal Attachment and
Infant Temperament in Teenage Mothers in the Setting of Best Clinical Practice. Archives of Women’s Mental Health.
2005;8:191-199.
Dubowitz H, Black MM, Kerr MA, Hussey JM, Morrel TM, Everson MD, Starr RH. Type and Timing of Mothers’ Victimization: Effects on Mothers and Children. Pediatrics. 2001;107(4):728-735.
Module 7
This study demonstrates the importance of educating victims about how DV can affect
their mental health, their parenting skills, and ultimately, their children’s well-being.
Module 7
Domestic violence is a well-documented risk factor for child abuse.
Rumm PD, Cummings P, Krauss MR, Bell MA, Rivara FP. Identified spouse abuse as a risk factor for child abuse. Child
Abuse and Neglect. 2000;24(11):1375-1381.
Findings indicate that domestic violence during the first six months of a child’s life is
significantly related to physical abuse, psychological abuse, and neglect up to a child’s
fifth year.
Among home visited families, domestic violence occurred among 38% of the cases of
confirmed child abuse.
McGuigan WM, Pratt CC. The predictive impact of domestic violence on three types of child maltreatment. Child
Abuse & Neglect. 2001;25:869-883.
Module 7
This study was conducted with a large sample of 2,544 mothers of first-born children
who participated in a Healthy Start home visitation program designed to prevent child
abuse among higher risk families.
Module 7
Edleson JL, Mbilinyi LF, Shetty, S. Parenting in the context of domestic violence. San Francisco, CA. 2003; Judicial Council of California.
Holden GW, Ritchie KL. Linking extreme marital discord, child rearing, and child behavior problems: Evidence from battered women. Child Development, 1991; 62, 311-327.
Holden, Stein, Ritchie, Harris, Jouriles, Children exposed to maritial violence: Theory, research and applied issues, 1998
pp. 289-334.
Module 7
Levendosky AA, Huth-Bocks AC, Shapiro DL, & Semel MA. The impact of domestic violence on the maternal-child relationship and preschool-age children’s functioning. Journal of Family Psychology, 2003; 17, 275-287.
Module 7
Strengthening mother-child bonding is a key strategy for helping children exposed to
violence that fits well with home visitation programs’ emphasis on building relationships
and promoting healthy parenting skills.
Bancroft L, Silverman J. The Batterer as Parent. 2002. Sage Publications, Thousand Oaks, California.
1. Have there been times when you have given in to the children—let them get away
with things because you feel guilty about what was occurring in your relationship?
2. Have there been times when you have not disciplined or corrected the children to
make up for the way the batterer has disciplined them?
This information, including the worksheet for mothers, is from the “Understanding Together” workbook that is part of
the KISS resources that were previously noted
Pennsylvania Coalition Against Domestic Violence. A Kid is So Special (KISS). 2008. www.pcadv.org
Module 7
Notes to Trainer: This slide provides examples of how victimization can negatively impact a mother’s parenting skills. This slide is adapted from a worksheet that is designed
for mothers to review and discuss with a domestic violence advocate during home visits.
This tool can be adapted for use by home visitors to help mothers understand how
violence can compromise parenting skills and also help her identify things that she is
doing to help her children. After each example of a potential impact of victimization on
a mother’s parenting, there are questions for her to consider. For example, for “Letting
Children Make the Rules,” there are two questions to consider:
Module 7
1. What do you think about the partnership between the advocate and the home visitor?
2. Do you think that their working together made a difference with the case presented?
Why or why not?
3. Are there some other questions that they should have been asked?
4. How many of you have ever worked with a local DV advocacy program?
5. Final thoughts about what you saw? Doable? Concerns?
Module 7
Baker L, Cunningham A. Helping Children Thrive: Supporting Women Abuse Survivors as Mothers. 2004. www.lfac.
on.ca
Module 7
Baker L, Cunningham A. Helping Children Thrive: Supporting Women Abuse Survivors as Mothers. 2004. www.lfac.
on.ca
1. Trauma such as exposure to violence can affect how the brain organizes and develops
2. Trauma interferes with learning
3. Children can develop posttraumatic stress disorder (PTSD) due to exposure to violence
4. Trauma leads to other health problems
5. You can make a difference
6. It is never too late to change our brains!
Module 7
This booklet, part of the Amazing Brain Series developed by the Institute for Safe Families (www.instituteforsafefamilies.org), is a resource designed for parents. The information provided in the booklet can help parents to understand how violence affects early
brain development and may lead to predictable physical, mental, and behavioral problems. The booklet includes strategies that parents can use to support their children such
as telling children that the violence is not their fault and asking a child what they are
most worried about. A key message is also that we can help our brains to heal as adults.
Six key concepts in this Amazing Brain booklet are:
Module 7
Notes to Trainer: Copies can be purchased by contacting Jo Sterner at the Pennsylvania
Coalition Against Domestic Violence (PCADV) at 800-537-2238
The booklet is organized into two sections: one for service providers and one for women.
A wide range of topics are covered that address issues spanning from infancy through
adolescence to help service providers and mothers respond appropriately to children
exposed to domestic violence.
Baker L, Cunningham A. Helping Children Thrive: Supporting Women Abuse Survivors as Mothers. 2004. www.lfcc.
on.ca
Module 7
Notes to Trainer: This 75-page booklet can be downloaded at no cost, in English and
French, at: www.lfcc.on.ca
Module 7
Notes to Trainer: This as an important partnership between home visitation and domestic violence programs.
Ask participants for a show of hands to see if they currently use shelter partnership as a
way to enroll women in your home visitation program.
• In this randomized, controlled trial, home visits were provided by a therapist and
graduate student team for up to eight months after the mother and child(ren) left
the domestic violence shelter
• The median number of home visits was twenty-three
• The prevalence of conduct problems was 15% among children (ages 4 to 9 years old
at the start of the study) who received the intervention compared to 53% among
children in the control group. Children in the control group received “usual care.”
• Aggressive child management strategies were defined as slapping, hitting, and
spanking.
McDonald R, Jouriles EN, Skopp NA. Reducing Conduct Problems Among Children Brought to Women’s Shelters: Intervention Effects 24 Months Following Termination of Services. Journal of Family Psychology. 2006;20(1):127-136.
Module 8: Childhood Exposure
to Domestic Violence
and Its Impact on
Parenting
Module 8
Training Outline
•
•
•
•
•
Learning objectives
Information on the effects of violence on parenting
Past exposure to violence and resiliency
Universal education with safety card
Video clip and role play with safety card
Overview
The following slides introduce the issue of adults’ childhood experiences with violence. This topic will be
addressed in the home visitor video clip and role play. We discuss the role of the home visitor in talking with
parents about their childhood experiences, using the Loving Parents, Loving Kids safety card featured in the
slides.
Acknowledge that parenting is personal, subjective and can be difficult—especially if there is a history of
violence or current violence.
Explain how talking with parents about their experiences as children can be a platform for discussing safe
homes, safe strategies for caring for children, and what it means to be in a healthy relationship.
Remind home visitors that parents who seem uncaring or neglectful—may not know another way based
on their life experiences. If we believe change can happen—they are more likely to believe it too.
Notes to Trainer: Begin by introducing the learning objectives for this module and then
review the slides on the impact of violence on parenting and resiliency.
Module 8
Exercise Activity Time: 10 minutes
Notes to Trainer: Read the case study below aloud to participants.
Module 8
“Stella is a survivor of childhood exposure to domestic violence and childhood sexual abuse by her father. Prior to
having her son (planned pregnancy) at age 23, she had undergone therapy for her abuse, taken classes on the subject,
and felt she had ‘dealt’ with her issues.
When her son is about 6 months old, she stops bathing him in the kitchen sink and moves him to the regular bathtub. As she puts him in the water, she has a flashback to her own abuse as a child that occurred in the bathroom. Her
hands and feet get numb, she hyperventilates—can’t catch her breath, starts crying—all the while realizing that her
helpless baby could drown if she doesn’t get him out of the tub right now. She pulls him out—and later that evening
tells her husband that he has to bathe the baby in the tub from now on.
Stella was totally surprised by what happened, nothing could have prepared her for it, and it came from a place inside
her that she didn’t know was there.”
Questions for the audience:
1.
Do you think she told her pediatrician or doctor about what happened the first time she tried to give her baby a
bath?” (The audience will probably say no; if they do not respond “no”, you can advise the audience that she did
not tell her pediatrician).
2.
Why do you think that she did not tell her pediatrician? (Examples of responses will probably include that she
was worried that her baby would be taken away by social worker and she would be seen as unfit as a mother).
3.
Did she tell friends or family? (The audience will probably respond that she may be afraid to tell her family depending on whether they know about the abuse she experienced, that she was ashamed to tell her friends etc.)
4.
Then ask: “Why did I share this case study with you?” (Explain that the goal of this case study and discussion is to
recognize the important role of home visitors in identifying issues that otherwise may not be addressed. Mothers
may not feel like talking about these issues from their past abuse unless a safe space is created for them to do so.
Home visits can provide the opportunity, when it is safe to do so, to problem solve and develop a plan for how to
support mothers and address triggers that may occur).
Kaufman, J., and E. Zigler, 1987, “Do Abused Children become Abusive Parents?” American Journal of Orthopsychiatry
57(2): 186-192
Kaufman, J., and E. Zigler, 1993, “The Intergenerational Transmission of Abuse is Overstated.” In Current Controversies
in Family Violence. Edited by R. J Gelles and D. R. Loseke, Newbury Park, CA: Sage Publications.
Higgins, Gina O’Connell (1994) Resilient Adults: Overcoming a Cruel Past (San Francisco: Jossey-Bass)
Module 8
Steele, Brandt F. (1997), “Further Reflections on the Therapy of Those Who Mistreat Children,” in Mary Edna Helfer,
Ruth S. Kempe, and Richard Kempe, and Richard D. Krugman, eds., The Battered Child, 5th addition (Chicago: University of Chicago Press), Chapter 26.
Module 8
Notes to Trainer: Clients may not be ready to disclose past experiences of childhood
victimization or exposure to violence. By using a universal education approach, you are
planting a seed for clients to recognize that adverse childhood experiences can influence
their parenting skills and how they react to stressful situations as adults.
Module 8
Module 8
Notes to Trainer: Hand out Loving Parent, Loving Kids safety cards
(order at www.FuturesWithoutViolence.org/health) to participants.
Module 8
Module 8
Notes to Trainer: Show the video clip of the home visitor talking to a client about the
Loving Parents, Loving Kids safety card (Ms. Macon, Tiffany and Richie: Home Visitation
and the Impact of Childhood Exposure to Violence on Parenting).
Then discuss the video clip. Questions to ask include:
• Was the home visitor able to build rapport with the client?
• What did you think about the way Ms. Macon offered universal education to Tiffany
about childhood exposure to violence? Did it feel judgmental?
• Did the client feel like she/he was being judged? Did the home visitor make the client
feel comfortable when discussing childhood exposure to violence?
• Could discussing childhood exposure to violence with the client create the opportunity to also ask about domestic violence and/or discuss healthy relationships?
• How did Ms. Macon handle Richie coming into the picture? What do you think about
the idea of educating both fathers and mothers about the impact violence can have
on their parenting?
Notes to Trainer
• Ask participants to form groups of three with each person taking one of the following roles: home visitor, client, and observer.
• Allow five minutes for the role play and 5-7 minutes for discussion.
• Read the following information for this role play:
Your client is a 19-year old mother of a newborn infant and the discussion is about childhood
exposure.
• Advise observers to note what the home visitor said that worked well.
• Ask participants who role played observers:
How did the home visitor introduce the safety card? Did she/he make the discussion comfortable? What would you have liked to see more of?
• Ask participants who role played as clients:
How did you feel? What would help you to feel more comfortable talking about this?
• Ask participants who role played home visitors:
Were you comfortable talking about the card panels? If not, what did you wish you had more of
to make this work better for you?
Module 8
The home visitor should use the Loving Parents, Loving Kids safety card to discuss childhood exposure to violence with this mother by focusing on the following two panels on the card: “What
About Your Childhood?” and “Parenting is Hard Work.” If you are the home visitor, your goal is
to use the card to introduce the concept that childhood exposure to violence can affect parenting, discuss possible steps that your client can take if she is feeling out of control or triggered by
something happening with her baby, and point out the helpline phone number that is included
on the safety card.
Module 9: Fathering After
Violence
Training Outline
•
•
•
•
•
Learning objectives
Characteristics of parenting by men who batter
Fathering after domestic violence initiatives
Something My Father Would Do DVD
Resource on parenting after violence
Module 9
Overview
Men who perpetrate domestic violence often have unhealthy parenting patterns that
cause further harm to children who may already be traumatized from witnessing violence. This module covers interventions that promote empathy within fathers by educating them about how violence affects their children. These interventions have shown
success with some fathers in reducing violent behaviors and improving parenting skills.
Module 9
Bent-Goodley TB. Health Disparites and Violence Against Women Why and How Cultural and Societal Influences Matter. Trauma Violence Abuse. April 2007 vol. 8 no. 2 90-104.
Module 9
Silverman JG, Williamson GM. Social ecology and entitlements involved in battering by heterosexual college males:
contributions of family and peers. Violence and Victims. 1997;12(2):147-165.
Module 9
Notes to Trainer: As we learn more about the effects of exposure to violence on children, we are also learning more about how being abusive in a relationship affects parenting. Researchers and service providers have observed how fathers who perpetrate
domestic violence often parent differently. This list describes some of the negative parenting styles that abusers may use. This information is from a resource called “Parenting
After Violence” which can be downloaded at www.instituteforsafefamilies.org. Examples
of negative parenting styles are provided below:
• Controlling: Controlling behavior is a hallmark of domestic violence and usually extends to the children; never allowing a child to make any choices can make them feel
helpless.
• Very strict discipline and physical punishment: There can be many negative consequences of using physical discipline; these experiences can reinforce that it is acceptable to hit and hurt people whom you love.
• Undermining and/or interfering with mother’s parenting: Examples include criticizing the mother in front of the children, teaching the children to put their mother
down and call her names, telling children that they do not have to do what their
mother asks them to do.
• Using the children to meet their needs: Examples include asking children to report
back about what their mother is doing, who she talks to, or where she goes.
• Limited sense of age appropriateness: Abusers often have unrealistic expectations
of their children, do not understand age–appropriate behaviors, and use inappropriate discipline methods.
Giving men more opportunities for change and healing is an essential component to end
violence against women and children.
Dovovan RJ, Paterson D, Francas M. Targeting male perpetrators of intimate partner violence: Western Australia’s
“Freedom from Fear” campaign. Social Marketing Quarterly. 1999;5(3):128-144.
Module 9
Dubowitz H, Black MM, Kerr MA, Hussey JM, Morrel TM, Everson MD, Starr RH. Type and Timing of Mothers’ Victimization: Effects on Mothers and Children. Pediatrics. 2001;107(4):728-735.
Notes to Trainer: Guiding principles for fathering after violence programs include:
• That the safety of women and children always comes first
• That this work must be informed by the experiences of battered women and children
• Critical awareness of cultural context in which parenting occurs
• Abuse is a deliberate choice and a learned behavior that must be unlearned
• Working with fathers is an essential piece of ending violence against women and
children
• Work with fathers must embrace notions of non-violence broadly
• Service coordination is essential
Examples of fathering after DV programs include:
• Domestic Abuse Project, Minneapolis, MN
Module 9
• Child Witness to Violence Project, Boston, MA
Notes to Trainer: Review the DVD before the training and consider showing at least one
of the men’s stories and asking some of the discussion questions below:
Module 9
QUESTIONS
• What is your first impression about this story?
• What did you like the best and least about this story?
• What does this story tell you about fatherhood and violence?
• What does this story tell you about the effects of violence on children? How does
domestic violence affect children across the lifespan?
• How do you think culture may affect this man’s life choices?
Module 10: Preparing Your
Program and
Supporting Staff
Exposed to Violence
and Trauma
Module 10
Training Outline
•
•
•
•
•
•
Learning objectives
Brainstorming session on strategies to enhance home visitors’ safety
Secondary traumatic stress
Handout on common reactions to working with trauma
Strategies for home visitors and program managers
Organizational self-assessment tool Overview
Working with clients who experience trauma can affect the caregiver/service provider, creating secondary traumatic
stress. This module reviews personal safety and self-care strategies for caregivers and policies that managers can
implement to support their staff.
The subsequent slides can be used as a large group brainstorming session to ask participants what they do to enhance their safety during home visits, especially when they suspect or know that domestic violence is occurring in a
household.
Review the explanation of secondary traumatic stress and acknowledge that personal experiences with violence can
impact how home visitors respond to clients experiencing violence and vulnerability to secondary traumatic stress.
Then provide the handout on common reactions to caring for survivors of trauma and give participants a few minutes
to review the handout.
Home visitors face unique challenges and risks when working with families who are experiencing domestic violence.
Home visitors may see things while visiting clients in their homes that other service providers working with the same
family are not aware of such as escalating tension, threatening behaviors, and signs of violence (broken furniture,
hole in the wall etc.). Because a home visitor may be in the home when physical violence erupts, it is essential that
home visitation programs have a safety protocol for staff to follow when they are working with families experiencing
domestic violence.
Module 10
Module 10
Notes to Trainer: Other service providers that work with families experiencing domestic violence and
have contact with families in their homes may have protocols and safety strategies that could be helpful
for home visitors.
Inviting service providers such as police officers and child protection workers to do a brown bag lunch
training provides the opportunity for cross-training and building partnerships between agencies that are
often working with the same families.
These safety strategies are discussed along with other practical lessons learned about working with domestic
violence within the context of home visits in the following publication:
“Chamberlain L. Addressing Domestic Violence within the Context of Home Visitation”
This is a great topic for brainstorming. Ask participants what they do to stay safe during home visits, especially when they have concerns about a particular situation. Create a list of strategies that the audience
recommends (working together as pairs to do home visits, wearing slip on shoes that can be slipped into
quickly, keep car keys easily accessible, etc.)
Home visitors have emphasized how important it is to look for behavioral clues and to always be aware
and to not get too comfortable that you ignore warning signs that it may not be a safe situation.
Chamberlain L. Addressing Domestic Violence within the Context of Home Visitation. Journal of Emotional Abuse,
Volume 8 (1/2): 2008; available online at http://jea.haworthpress.com
Module 10
Module 10
Encourage program managers to implement strength-based practices so that only staff
who have had training on domestic violence, who are comfortable with doing screening, and who are prepared to respond appropriately to disclosures are doing assessment
with clients.
Module 10
Notes to Trainer: Workplaces Respond to Domestic and Sexual Violence: A National Resource Center, makes it easier than ever for employers to adopt vitally important policies
to protect employees from domestic and sexual violence. The new Center was formed
by a partnership of seven national organizations led by Futures Without Violence, and
funded by the Justice Department’s Office on Violence Against Women (OVW). For more
information, visit: www.workplacesrespond.org
Module 10
Trauma-informed Organizational Self Assessment. The National Center on Family Homelessness. Download at www.familyhomelessness.org
Module 11: Mandated Reporting
for Child Abuse:
Challenges and
Considerations
Module 11
Training Outline
•
•
•
•
Learning objectives
Key considerations
Supporting mothers
Resource
Overview
This module offers a brief introduction to a complex topic that should be part of continuing education for home visitors. While all states have mandated reporting for child
abuse, requirements and procedures vary considerably by county and state. It is important for trainers to be aware of local response practices. Trainers should consult with
their local child protection agency before doing any training to learn the basics and have
referral information for further training and consultation available.
If time allows, this module provides an excellent opportunity for a guest speaker to talk
about mandated reporting for child abuse in your jurisdiction.
For more information on state laws and regulations go to: www.FuturesWithoutViolence.org to see a compendium of state statutes and policies on DV and healthcare.
Module 11
Module 11
Notes to Trainer: Encourage home visitors to request and program managers to arrange
cross-training with their local/regional child protection agencies. It is very helpful to include domestic violence advocates in these trainings to identify strategies for collaboration on cases where domestic violence and child maltreatment are co-occurring. Periodic
brown bag lunches or other opportunities for home visitors, child welfare workers and
domestic violence advocates to meet and brainstorm about best practices can lead to a
more coordinated response to domestic violence and child maltreatment.
Ways to involve the client in the process include asking if she would like to be present
when you make the report if that is safe to do and keeping her informed about the
process.
Encourage participants to contact local domestic violence program/shelter and domestic
violence coalitions in their state to learn about additional training, consultation on particular cases, and resources for their clients.
Remind participants that making a report can never substitute for the important care
they provide.
Module 11
Notes to Trainer: Before you do training, learn about the reporting requirement for your
county. Information that you will need to know includes:
• Who is required to report?
• What must be reported?
• To whom is the report made?
• What are the likely outcomes of calling the police or child protective services?
• What are the safety considerations you can address with your client?
• Are there provisions for confidentiality of reports?
IMPORTANT TIP: Before you ask about anything that the client may be worried about being reportable—(INCLUDING immigration status) always discuss limits of confidentiality:
Module 11
(This is a good example of something you might consider using on the top of a self administered form or put on the top of the form the staff fill out so they don’t forget).
It is important to research what the law and requirements are in your county/state
regarding reporting domestic violence prior to conducting any training. You can add
additional slides to this module about what is required in your area and you should be
prepared for questions on this topic and offer contacts for additional information and
questions that you may not be able to answer.
Module 11
Module 12: Closing and PostTraining Survey
Training Outline
• “Where am I” exercise
• Post-training survey
Overview
Module 12
If time allows, you can solicit feedback from participants as you transition to the next
slide on the “Where Am I” exercise. Ask participants to reflect back to the “Where Am I?”
exercise that they completed at the beginning of the training and think about how this
training may have impacted their comfort level with addressing domestic violence during
home visits.
Notes to Trainer: Ask participants if anyone would like to share their observations about
any impact that the training has had on their level of comfort with addressing domestic
violence with clients.
A key strategy for effective trainers is always having the last word at a training. Complete
the discussion and then provide your closing comments about what you want the participants to take home from this training.
Module 12
Module 12
Notes to Trainer: Hand-out the post-training survey for participants to complete and
provide your contact information for any questions and follow-up.
Remind participants that their responses are confidential.
Share your closing thoughts and thank participants for their time, expertise, and dedication to making a difference for the families and communities they work with.
Module 12
Appendices
Appendix A
PRE-TRAINING SURVEY
FOR HOME VISITORS
Thank you very much for joining us!
As you know, exposure to violence is associated with multiple poor health outcomes for children and
their families, and is likely to impact the lives of many of the families you work with and support. We
are developing ways to improve how we talk about domestic violence, sexual violence, and childhood violence experiences with our families.
We would like to ask you a few questions about your experiences as a home visitor talking to your
clients about healthy relationships and violence in the home, and in what areas you would like to
have additional training and support.
Please take a few moments to answer the following questions. Your responses will be kept confidential. You may skip any questions that you do not want to answer, and you can stop taking the survey
at any time.
We would also like to contact you in a few months to find out how useful this training was to you in
practice, whether you were able to use any of the components presented, and to have you reflect on
additional training, resources, and supports you want to see.
We greatly appreciate your taking the time to answer these questions for us as we aim to improve
the violence prevention and intervention trainings for home visitation programs.
1
Pre-Training Survey for Home Visitors
A) Yes
B) No
2) Have you ever had training on how domestic violence (DV) can affect parents’ health?
A) Yes
B) No
3) Have you ever had training on how experiencing violence during childhood (child abuse and
witnessing domestic violence) can affect parents’ health?
A) Yes
B) No
4) I feel confident that I can talk to a parent (male or female) about violence in the home and
how this can affect their child’s health.
A) Strongly disagree
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
5) I feel confident that I can assess for domestic violence (DV) with parents in my home visitation
program.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
6) I feel confident that I can talk to a parent (male or female) about how experiencing violence
during childhood might affect one’s parenting.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
2
Appendix A
1) Have you ever had training on domestic violence (DV)?
Appendix A
7) I feel confident talking with my female clients about birth control including whether their partners are supportive of their using it.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
8) When a female client has told me that her pregnancy was unplanned, I feel confident asking if
she feels her partner was trying to get her pregnant when she didn’t want to be.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
9) I feel confident educating female clients about birth control their male partner cannot interfere with (example IUD, Implanon, Depo).
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
10)When a female client has another pregnancy shortly after her first baby, I feel confident asking
if there is anyone who will hurt her if she doesn’t do what they want with the pregnancy.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
11)I am comfortable helping a client needing services for DV.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
3
for mothers and children.
B) Disagree
C) Neutral
D) Agree
E) Strongly agree
13)How often are you giving your clients a safety card about domestic violence?
A) All of the time (100%)
B) Most of the time (75% or more)
C) Some of the time (25% - 75%)
D) Not so often (10% - 25%)
E) Rarely (less than 10%)
14)How often do you review the limits of confidentiality with your clients before asking about
coercion or violence?
(i.e., based on your state’s reporting laws, telling the clients what you are required to report
like whether they are at risk of hurting themselves? )
15)How often do you assess for domestic violence (DV) with new clients?
16)How often do you assess for domestic violence (DV) when a client tells you s/he is feeling
depressed?
4
Appendix A
12)I understand the possible implications of making a report to child welfare or law enforcement
Appendix A
17)How often do you assess for domestic violence (DV) when a client is smoking, drinking alcohol
or using other drugs while pregnant?
18)What are reasons that you may not address domestic violence (DV) during a home visit?
(circle all that apply)
A) Not enough time
B) It’s not my job or in my job description
C) Asking doesn’t help
D) The partner is present for the visit
E) Worried about upsetting the client
F) Not sure what to say if they disclose an abusive/violent relationship
G) Afraid what would happen if they told me
H) Not sure how to ask questions without seeming too intrusive
I) Not knowing where to refer them to
J) Worried about mandated reporting
K) Have already screened them at past visit
L) Does not apply to my client population
M) Other __________________________________________________________________
19)What are reasons that you may not discuss the adult clients’ experiences with violence during
their own childhood? (circle all that apply)
A) Not enough time
B) The partner is present for the visit
C) Worried about upsetting the client
D) Not sure what to say if they disclose a history of childhood abuse
E) Afraid what would happen if they told me
F) Not sure how to ask questions without seeming too intrusive
G) Not knowing where to refer them to
H) Worried about mandated reporting
I) Have already screened them at past visit
J) Does not apply to my client population
K) Other _________________________________________________________________
5
tims of domestic violence (current as well as lifetime experiences)?
A) 75% or higher
B) 50% or higher
C) 25% or higher
D) 10% or higher
E) None
21)In the past 6 months, how many of your own clients have shared with you that they experienced childhood abuse, including witnessing violence between adult caregivers?
A) 75% or higher
B) 50% or higher
C) 25% or higher
D) 10% or higher
E) None
22)As part of your home visits, are there specific protocols about what to do when a client discloses domestic violence (DV)?
A) Yes
B) No
C) Not applicable
D) Don’t know
23)As part of your home visits, are there specific protocols about what to do when a client discloses their own experiences with violence as a child (childhood abuse, witnessing DV)?
A) Yes
B) No
C) Not applicable
D) Don’t know
24)As part of your home visits, are there any instructions/protocols on how to file a report to
child welfare?
A) Yes
B) No
C) Not applicable
D) Don’t know
6
Appendix A
20)In the past 6 months, how many of your own clients have disclosed to you that they are vic-
Appendix A
25)As part of your home visits, are there scripted tools or written instructions on how to do safety
planning with clients who disclose domestic violence (DV)?
A) Yes
B) No
C) Not applicable
D) Don’t know
26)Does your home visitation program have (circle all that apply):
A) Brochures, cards or information about domestic violence (DV), and childhood exposure to
violence (CEV) and parenting?
B) Prompts inserted into intake forms to assess for DV/CEV?
C) In-service trainings for all staff on DV/CEV?
D) Materials on DV that are specifically targeted to teen parents?
E) Other (please be as specific as you can): ___________________________________________
______________________________________________________________________________
________________________________________________________________________
27)Are educational materials available on domestic violence (DV) in the languages most commonly spoken in your program?
A) Yes
B) No
C) Not sure
28)What support do you need to incorporate discussion of DV/CEV in all your home visits? (circle
all that apply)
A) Workshops and training sessions
B) Protocols that include specific questions to ask
C) List of violence-related resources and who to call with questions
D) Case consultation
E) Online training
F) Other (Please specify) __________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Thank you for your time!
8
Appendix A
Additional Comments: ________________________________________________________
POWER
AND CONTROL WHEEL
Forms of Domestic Violence that Women Experience
Forms of domestic violence that women experience
Appendix B
This version of the Power and Control wheel, adapted with permission from the Domestic Abuse
Intervention
Project
Duluth,
focuses
on some
of the many
ways
This version
of theinPower
andMinnesota,
Control wheel,
adapted
with permission
from
thebattered
Domesticimmigrant
Abuse
women
can
be
abused.
Intervention Project in Deluth, Minnesota, focuses on some of the many ways battered immigrant
women can be abused.
Adapted by Futures Without Violence, www.futureswithoutviolence.org.
Adapted by the Family Violence Prevention Fund, www.endabuse.org.
DOMESTIC VIOLENCE: THE SILENT WAR AGAINST WOMEN
59
CULTURAL COMPETENCY
CASE STUDY
Definitions:
Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a
system, agency, or among professionals that enables effective work in cross-cultural-situations.
Source: US Department of Health and Human Services. (2005). what is cultural competency? www.omhrc.gov/templates/
browse.aspx?lvl=2&lvlID=11
Appendix C
Linguistic competence is the capacity of an organization or personnel to communicate effectively,
and convey information in a way that is easily understood by diverse audiences including persons of
limited English proficiency, those who have low literacy skills, and individuals with disabilities
Source: Goode T, Jones W. (2004) Definition of linguistic competence, National Center for Cultural Competence. Washington, DC; National Center for Cultural Competence, Georgetown University Center for Child and Human Development.
www11.georgetown .edu/research/gucchd/nccc/foundations/frameworks.html
Case Study:
Lia, a 32-year-old woman from the Dominican Republic, is diagnosed with syphilis. She has been in
the United State with her husband and four children for three years. She is pregnant and is afraid
to tell her husband that she has the disease for fear that he will be angry with her. She speaks very
limited English, and her primary language is Spanish. Lia decides to disclose this information to her
home visitor who she is developing a trusting relationship with. The home visitor is from a different cultural background and does not speak Spanish. Lia is reluctant to talk about her problem but
nervously tries although communication between the home visitor and Lia is very poor because Lia is
embarrassed that she does not speak English very well and is afraid to share her feelings. The home
visitor knows that Lia’s husband is quite fluent in English and asks her if she should come back when
he is home so that they can discuss where they can go for treatment and talk about using condoms.
Lia becomes very quiet and says that she does not want to talk about this again.
(ENGLISH AND SPANISH)
Appendix D
EXAMPLE OF THE HEALTHY MOMS,
HAPPY BABIES SAFETY CARDS
Tear out these sample cards and fold them to wallet size. To order additional cards for your program
go to: www.FuturesWithoutViolence.org/health.
Plan de Seguridad
Si su pareja la está lastimando, usted no tiene la culpa. Usted merece estar
segura y ser tratada con respeto.
Si su seguridad está en riesgo:
Safety Planning
If you are being hurt by a partner it is not your fault. You deserve to be safe
and treated with respect.
If your safety is at risk:
1.Llame al 911 si corre peligro inmediato.
1.Call 911 if you are in immediate danger.
2.Prepare un paquete de emergencia, en caso de que tenga que irse
repentinamente, que incluya: dinero, chequera, llaves, medicinas,
una muda de ropa, y documentos importantes.
3.Hable con su visitador domiciliario para ayuda con llamadas a
líneas de asistencia locales o nacionales, para la atención de la
violencia doméstica y para más información
sobre planeación de seguridad.
2.Prepare an emergency kit in case you have to leave suddenly with:
money, checkbook, keys, medicines, a change of clothes, and
important documents.
3.Talk to your home visitor for help calling the local or national
domestic violence hotline for additional information
on safety planning.
FOLD >
Tomando el Control
Referencias Pueden Ayudar
Buscando apoyo para usted y sus hijos le puede ayudar a avanzar hacia un
futuro más saludable—aún el paso más poqueño es algo para celebrar.
Mientras que programas de la violencia doméstica locales y nacionales pueden ayudar con
su plan de seguridad y pueden proporcionarle con referencias a refugios seguros, también
ofrecen servícios para mujeres que no quieran, o no están listas para irse al refugio.
Muchos programas ofrecen:
•
•
grupos de apoyo para mujeres y programas para niños.
clases para fomentar su confidencia, planear para su futuro, y
apoyarle en la crianza de sus hijos—llame a su programa local
para averiguar lo que está disponible.
FOLD >
Formerly Family Violence Prevention Fund
FuturesWithoutViolence.org
©2011 Futures Without Violence.
All rights reserved.
FOLD >
Funded by the Administration on Children,
Youth and Families, U.S. Department of
Health and Human Services and the Office
on Women’s Health, U.S. Department of
Health and Human Services.
Líneas directas nacionales pueden
conectarle a los recursos locales y
proporcionarle apoyo:
Para obtener apoyo gratuito, las 24
horas del día, llame:
Línea Nacional Sobre la Violencia
Doméstica
1-800-799-SAFE (1-800-799-7233)
TTY 1-800-787-3224
Línea Nacional sobre el Abuso de
Novios Adolescentes
1-866-331-9474
Línea Directa para la Atención de
Casos de Violencia Sexual
1-800-656-4673
Taking Control Back
Referrals Can Help
Getting support for yourself and your children can help you move toward a
healthier future—even the smallest step is something to celebrate.
While local and national domestic violence programs can help with safety planning and
provide referrals to safe shelters, they also provide services for women who may not want
or be ready to go to shelter. Many programs have:
•
•
drop-in support groups for women and programs for children.
classes to build confidence, plan for the future and support your
parenting—call your local program to find
out what is available.
National hotlines can connect
you to your local resources and
provide support:
For free help 24 hours a day, call:
National Domestic Violence Hotline
1-800-799-SAFE (1-800-799-7233)
TTY 1-800-787-3224
Teen Dating Abuse Hotline
1-866-331-9474
Rape, Abuse, Incest,
National Networks (RAINN)
1-800-656-HOPE (1-800-656-4673)
Mamás Sanas,
Hijos Felices:
Healthy Moms,
Happy Babies:
Creando Futuros Sin Violencia
Creating Futures without Violence
¿Cómo le va?
How is it Going?
If you answered YES to any of these questions, it is likely that you are in a
healthy relationship. Studies show that this kind of relationship leads to better
health, longer life, and better outcomes
for children.
Si usted contestó SÍ a algunas de estas preguntas, es probable que usted está en
una relación sana. Los estudios muestran que este tipo de relación lleva a una
vida más saludable y larga, y mejores resultados
para sus hijos.
4 Does my partner support my decisions about if or when I want to
have more children?
4 ¿Mi pareja apoya mis decisiones sobre cuándo o si quiero tener
más hijos?
4 Does my partner give me space to be with friends or family (or to
take breaks from the baby)?
4 ¿Mi pareja me da espacio para salir con amigos o familia (o tomar
descansos del bebé)?
4 Do I feel respected, cared for and nurtured by my partner?
4 ¿Me siento respetada, cuidada, y apoyada por mi pareja?
All moms deserve healthy relationships. Ask yourself:
Toda mamá merece relaciones sanas. Pregúntese:
< FOLD
¿Qué tal los días malos?
On Bad Days?
If you answered YES to any of these questions, you don’t deserve to be hurt and
your home visitor can support you and connect
you to helpful programs.
Si usted contestó SÍ a algunas de estas preguntas, usted no merece ser lastimada
y su visitador domiciliario puede apoyarle y conectarle
con programas de ayuda.
4Does my partner threaten to hurt my children or my family?
4¿Mi pareja me amenaza con hacer daño a mis hijos o mi familia?
4Does my partner force me to do sexual things I don’t want to?
4¿Mi pareja me fuerza a hacer cosas sexuales que yo no quiero?
4Does my partner threaten me, hurt me, or make me feel afraid?
4¿Mi pareja me amenaza, me lastima, o me hace sentir miedo?
4Does my partner shame or humiliate me?
4¿Mi pareja me avergüenza o humilla?
Is my relationship unsafe or disrespectful? Ask yourself:
¿Estoy en una relación que no es segura o respetuosa? Pregúntese:
< FOLD
Know Your Rights
Conozca sus derechos.
¿Qué es lo que tiene que reportar su visitador domiciliario a las
autoridades?
•
•
•
< FOLD
Abuso infantil y negligencia.
Algunos estados requieren que la violencia doméstica sea reportada
a la policía, otros no la requieren.
Algunos estados tienen leyes que consideran la violencia doméstica
y/o el abuso de sustancias como abuso infantil y este puede resultar
en un informe al bienestar de menores.
Usted tiene el derecho de saber lo que su visitador domiciliario está
requerido a reportar. Pregunte a su visitador domiciliario sobre qué es
reportable y a quién.
What does your home visitor have to report to the authorities?
•
•
•
Child abuse and neglect.
A few states require that domestic violence must be reported to
the police, others do not.
A few states have laws that view domestic violence and/or
substance abuse as child abuse and this can result in a report to
child welfare.
You have the right to know what your home visitor is required to
report. Ask your home visitor about what is reportable and to whom.
Coping Strategies
Estrategias de afrontamiento
¿Cómo está su salud? ¿Cómo está haciendo frente? Pregúntese:
4¿Me siento tan triste que no puedo levantarme de la cama, o cuidar
del bebé?
4¿Estoy fumando más para calmarme?
4¿Estoy tomando alcohol, medicamentos con receta, u otras drogas
para aliviar el dolor?
4¿Alguna vez me he sentido tan triste que he pensado en el suicidio?
Si usted contestó SÍ a algunas de estas preguntas, puede ser el resultado del
estrés crónico. Hable con su visitador domiciliario inmediatamente sobre cómo
obtener ayuda.
How is your health, how are you coping? Ask yourself:
4Do I feel so sad I can’t get out of bed? Or take care of the baby?
4Am I smoking more to try and calm myself?
4Am I using alcohol, prescription medications, or other drugs to
make the pain go away?
4Do I ever feel so sad that I have thoughts of suicide?
If you answered YES to any of these questions, it may be the result of
chronic stress. Talk with your home visitor right away about how
to get help.
Appendix D
RELATIONSHIP ASSESSMENT TOOL
Date: This is a self-administered tool for clients to fill out. If the client was unable to complete this tool
today, was it because other people were present in the home? Circle one: Yes/No
_____________________________________________________________________________
(Note to home visitor: Please modify this script based on your state laws. This is just a sample script.)
“Everything you share with me is confidential. This means what you share with me is not reportable to child welfare, INS (Homeland Security) or law enforcement. There are just two things that I
would have to report- if you are suicidal, or your children are being harmed. The rest stays between us and helps me better understand how I can help you and the baby.”
We ask all our clients to complete this form. For every question below, please look at the scale
and select the number (1-6) that best reflects how you feel.
123 456
DisagreeDisagreeDisagree Agree Agree Agree
Strongly
Somewhat
a Little
a Little
Somewhat
Strongly
1) He makes me feel unsafe even in my own home.............................................................. ______
2) I feel ashamed of the things he does to me...................................................................... ______
3) I try not to rock the boat because I am afraid of what he might do................................. ______
4) I feel like I am programmed to react a certain way to him............................................... ______
5) I feel like he keeps me prisoner........................................................................................ ______
6) He makes me feel like I have no control over my life, no power, no protection............... ______
7) I hide the truth from others because I am afraid not to................................................... ______
8) I feel owned and controlled by him.................................................................................. ______
9) He can scare me without laying a hand on me................................................................. ______
10)He has a look that goes straight through me and terrifies me......................................... ______
Please turn the page and continue the survey. Thank you. Adapted from: Smith, P.H., Earp, J.A., & DeVellis, R. (1995), Development and validation of the
Women’s Experience with Battering (WEB)Scale. Women’s Health, 1, 273-288.
Appendix E
Other reason for not using tool today: ______________________________________________
Relationship Assessment Tool (page 2)
123 456
DisagreeDisagreeDisagree Agree Agree Agree
Strongly
Somewhat
a Little
a Little
Somewhat
Strongly
Appendix E
1) Has my partner ever physically hurt me? ___________
2) Has my partner ever forced me to do something sexual I didn’t want to? ______
Thank you for completing this survey. Please give it back to your home visitor so they can
complete the bottom portion.
Home visitors complete the next section:
1) What referrals and information were given to the client this session? (Please note, ALL clients
should have been given the Healthy Moms, Happy Babies safety card).
(Circle all that apply)
• Social Worker/Counselor
• Domestic Violence Hotline
• Local Domestic Violence Advocate/Program
• Healthy Moms, Happy Babies Safety Card
• Other (please specify):_______________________________________________________
2) Did you offer safety planning? (This should happen for any score higher than 20 for pages one
and two)
• Reviewed Safety Planning panel on Healthy Moms, Happy Babies card.
• Provided the Safety Plan and Instructions tool to my client.
• Provided domestic violence hotline numbers.
• Referred to domestic violence advocate for additional safety planning.
• Other (please specify): _______________________________________________________
Additional Client Education Sessions:
Reproductive Coercion and Parenting After Violence
1) Question for home visitors: When should I introduce the “What About Your Childhood” and
“Parenting is Hard Work” panels of the Loving Parents, Loving Kids safety card?
Conversation starter: “We have started talking to all our clients about this Loving Parent’s Card.
These two panels are really important because they talk about how your past can affect the way
you parent and give you strategies if you ever find yourself frustrated. On the back of the card is
a confidential 24/7 hotline in case you are feeling like you are having a hard time with the baby
and just need someone to listen.”
Date ____________ Card Panels Reviewed yes/no
2) Question for home visitors: When should I introduce the panels of the “Let’s talk Pregnancy”
and “Taking Control” Loving Parents, Loving Kids safety card?
Answer: During the 8th month/third trimester of her pregnancy or soon after the birth of the
baby.
Conversation starter: “One of the things we are talking to all our moms about is when and or
if they want another baby. Sometimes this decision isn’t hers to make. I wanted to go over the
‘Let’s Talk Pregnancy’ and ‘Taking Control’ sections of the Loving Parents, Loving Kids safety card
to see if you need any additional referrals.”
Date ____________ Card Panels Reviewed yes/no
What referrals and information were given to the client this session? (Please note, ALL clients should
have been given the Loving Parents, Loving Kids safety card).
• Social Worker/Counselor
• Child Help Hotline (on back of safety card)
• Local Domestic Violence Advocate/Program
• Loving Parents, Loving Kids Safety Card
• Reproductive Health Provider
• Appendix I - Birth Control Education Sheet Offered
• Other (please specify):________________________________
Appendix E
Answer: During the 8th month/third trimester of her pregnancy or soon after the birth of the
baby.
SAFETY PLAN AND INSTRUCTIONS
SAFETY PLAN
Step 1:
Safety during a violent incident. I can use some or all of the following strategies:
A) If I have/decide to leave my home, I will go______________________________________ .
B) I can tell____________________ (neighbors) about the violence and request they call the
police if they hear suspicious noises coming from my house.
C) I can teach my children how to use the telephone to contact the police.
D) I will use ____________________as my code word so someone can call for help.
Appendix F
E) I can keep my purse/car keys ready at (place) ___________________, in order to leave quickly.
F) I will use my judgment and intuition. If the situation is very serious, I can give my partner what
he/she wants to calm him/her down. I have to protect myself until I/we are out of danger.
Step 2:
Safety when preparing to leave. I can use some or all of the following safety strategies:
A) I will keep copies of important documents, keys, clothes and money at________________.
B) I will open a savings account by ____________, to increase my independence.
C) Other things I can do to increase my independence include:_______________________ .
D) I can keep change for my phone calls on me at all times. I understand that if I use my telephone,
credit card, or cell phone, the telephone bill or phone log will show my partner the numbers
that I called after I left.
E) I will check with ______________________ and my advocate to see who would be able to let
me stay with them or lend me some money.
F) If I plan to leave, I won’t tell my abuser in advance face-to-face, but I will leave a note or call
from a safe place.
Step 3:
Safety in my own residence (some of these things can be paid for by Victim of Crime Dollars for more
information www.ncjrs.gov/ovc_archives/factsheets/cvfvca.htm). Safety measures I can use include:
A) I can change the locks on my doors and windows as soon as possible.
B) I can replace wooden doors with steel/metal doors.
C) I can install additional locks, window bars, poles to wedge against doors, and electronic systems etc.
D) I can install motion lights outside.
E) I will teach my children how to make a collect call to me if my __________________________
partner takes the children.
F) I will tell people who take care of my children that my partner is not permitted to pick up my
children.
G) I can inform ___________________(neighbor) that my partner no longer resides with me and
they should call the police if he is observed near my residence.
Safety Plan and Instructions
Step 4.
Safety with a protection order. The following are steps that help the enforcement of my protection
order.
A) Always carry a certified copy with me and keep a photocopy.
B) I will give my protection order to police departments in the community where I work and live.
C) I can get my protection order to specify and describe all guns my partner may own and authorize a search for removal.
Next Step INSTRUCTIONS
Legal Considerations…
• Domestic Violence is a crime and you have the right to legal intervention. You should consider
• If you have injuries, ask a doctor or nurse to take photos of your injuries to become part of your
medical record.
CALLING THE POLICE*
When someone has injured you or violated a restraining order, criminal stay-away order or emergency protective order, do the following:
1) Call the police at 911, if it is an emergency. Tell them you are in danger and you need help immediately. Let them know if you have a court order. If the police do not come quickly, call again and
say “This is my second call.” Note the time and date of your call(s).
2) When the police arrive, tell them only what your partner or ex-partner did. Describe your
injuries, how you were injured or how he violated a restraining order, and if your partner or expartner used weapons. If he has violated a restraining order, show the police your order and any
proof of service. Ask that the police file a report and give you a report number.
3) Tell the officers that the attacker will come back and beat you unless they make an arrest. If the
police make an arrest and take the attacker into custody, you should be aware that he/she could
be released within a few hours. You can use those hours to get to a safer place.
4) If you don’t have a restraining order or an injunction for protection, ask the officer for an Emergency Protective Order. This is an order that may protect you until you obtain a criminal stayaway order or restraining order.
5) Always get the police officers’ names and badge numbers. If you have trouble with a police officer, you can complain directly to the Chief of Police or to the officer’s supervisor.
6) If the violator is arrested and taken to the police station, he/she may be charged and he/she will
probably be released on bail or, in certain circumstances, without bail until the hearing. Ask that
a condition of his release be that he should not come near you. This process may take from 2 to
48 hours.
Appendix F
calling the police for assistance. You may also obtain a court order prohibiting your partner from
contacting you in any way (including in person or by phone). Contact a local DV program or an
attorney for more information.
Safety Plan and Instructions
7) If the violator is not arrested you should call the prosecutor or police department about how to
follow-up with your complaint.
Appendix F
8) Keep a journal documenting what happened.
SAMPLE MEMORANDUM OF
UNDERSTANDING
Memorandum of Understanding (MOU) Between Home Visitation
and Domestic Violence Programs
Background
Home visitation programs are case management programs designed for pregnant and parenting
mothers of small children. These voluntary programs have been created for low-income mothers to
support their parenting and infant/toddler care through health education and by providing linkages
to local services. Home visitation programs help mothers with a range of issues, one of which is
domestic violence. Many home visitation programs are required to screen for domestic violence and
provide referrals to local domestic violence programs and national hotlines.
Some home visitation programs have already developed such relationships with their local domestic
violence agency. In fact, some partnerships have made it possible for the home visitor to bring the
advocate to meet with a woman as part of case management to encourage deeper participation in
domestic violence advocacy services. While we recognize that not all programs have this capacity,
this partnership can create an opportunity for a direct connection to a domestic violence program
that she might otherwise not make.
A second goal in developing a partnership between home visitation and domestic violence services
is to create opportunities to connect pregnant and parenting women to home visitation services
while they are in shelter. Developing a trusting relationship with the home visitation program is a
way to extend support to women beyond shelter and help her connect to case management services that would be more trauma and violence informed through a partnership between agencies.
This recommendation comes with caveats. Of course it would be essential that home visitation
staff signed a confidentiality agreement if they were to come to the shelter in the same way advocates do and promise not to reveal the location of the shelter and the location of the mother and
her children.
Appendix G
The goal of this MOU is twofold. The first goal is to help establish a deeper relationship between
home visitation and domestic violence programs and support ‘warm’ referrals. As an example of
why deeper program partnerships can make a difference in conversation with clients, we are working with home visitors so referrals are more like: “If you are comfortable with this idea, I would like
to call Sherrie from Safe Haven (local DV program), she is really kind and has worked with many,
many women in your shoes.” Verses—“Here is a hotline number in case you need to call.” When
personal connections are made between programs it helps clients feel safer accessing support and
taking action.
The parties listed above and whose designated agents have signed this document agree that:
1) __________________________ (home visitation program) and __________________________
(domestic violence program) will meet with each other once per year to understand the
services currently provided by their respective programs and review referral policies between
agencies.
2) When domestic violence is identified by home visitation, _______________________________
(home visitation program) will review advocacy services available and provide referral to
__________________________ (domestic violence programs).
3) Any home visitor assigned to providing services to pregnant or parenting women at the shelter
will complete any/all confidentiality agreements required by the shelter to ensure client safety
and to assure that the location of the shelter remain confidential and not shared with ANYONE including friends and family, __________________________ (home visitation program)
will take all precautions to ensure victim/survivor safety and assign staff to work with shelter
clients that have training on domestic violence.
4) __________________________ (domestic violence agency) and __________________________
Appendix G
(home visitation program) agree to work to the amount feasible to ensure that each family has
a consistent staff member assigned to assist them and to minimize the transfer of cases involving domestic violence.
5) __________________________ (domestic violence program) agrees to provide every victim/
survivor seeking services with safety planning (including safety planning for children) and
information on how to meet their basic human needs (such as food, housing and clothing),
including offering to connect her to (home visitation program) as part of a supportive case
management plan.
We, the undersigned, approve and agree to the terms and conditions as outlined in this Memorandum of Understanding.
_____________________________________ Executive Director Domestic Violence Program _____________________________________
Executive Director
Home Visitation Program
_________________________
Date
_________________________
Date
(ENGLISH AND SPANISH)
Appendix H
EXAMPLE OF THE LOVING PARENTS,
LOVING KIDS SAFETY CARDS
Tear out these sample cards and fold them to wallet size. To order additional cards for your program
go to: www.FuturesWithoutViolence.org/health.
Hablemos acerca del embarazo
Let’s Talk Pregnancy
•
¿Mi pareja apoya mis decisiones en cuanto a si quiero o cuándo me
gustaría tener más hijos?
•
Does my partner support my decisions about if or when I want to
have more children?
•
•
•
¿Se niega mi pareja a usar condones cuando se lo pido?
•
•
•
Does my partner refuse to use condoms when I ask?
¿Mi pareja me obliga a tener sexo cuando yo no tengo ganas?
¿Ha intentado mi pareja embarazarme (recientemente o en el
pasado) sin que yo lo desee?
Los embarazos no planificados, especialmente aquellos que se dan
muy cerca de su primer embarazo, pueden dificultar que usted cuide
de los niños que ya tiene.
Does my partner make me have sex when I don’t want to?
Has my partner ever tried to get me pregnant (recently or in the
past) when I didn’t want to be?
Unplanned pregnancies, especially if they are closely timed after your
first pregnancy--can make it difficult to care for the
children you already have.
FOLD >
Cómo tomar el control
Taking Control
Es posible que su pareja vea el embarazo como una manera de mantenerle en su vida
y seguir cerca de usted a través de un hijo - incluso si eso no es lo que usted quiere.
Your partner may see pregnancy as a way to keep you in his life and keep
connected to you through a child—even if that isn’t what you want.
Si su pareja le presiona para tener sexo, trata de interferir con sus anticonceptivos o se
niega a usar condones:
If your partner pushes you to have sex, messes with your birth control or
refuses to use condoms:
1. Hable con su proveedor de servicios de salud acerca de métodos
anticonceptivos que pueda usar sin que su pareja sepa (por ejemplo - DIU,
anticonceptivos de emergencia (EC), Depo, Implanon).
2. Pregunte a su visitador domiciliario acerca de programas locales y nacionales
que se dedican a ayudar a las mujeres que batallan con problemas de control
o abuso en sus relaciones.
1.Talk with your health care provider about birth control that
you can control and that your partner doesn’t have to know about
(examples--IUD, Emergency Contraception (EC), Depo, Implanon).
FOLD >
2.Ask your home visitor about local and national programs to help
women struggling in their relationships
with control or abuse.
Si se siente frustrada o enojada
con sus hijos y sencillamente necesita
hablar...
If you are feeling frustrated or angry
with your child and just need to talk...
Para recibir asistencia confidencial llame a:
For confidential help call:
Ayuda para niños
1-800-422-4453
FOLD >
Si su pareja está haciéndole daño
usted no tiene la culpa. Para recibir
asistencia llame a:
Línea Directa Nacional para la Atención de la
Violencia Doméstica
1-800-799-7233
TTY 1-800-787-3224
Línea Directa para la Atención de Casos de
Violencia Sexual
1-800-656-4673
Child Help
1-800-422-4453
If you are being hurt by a partner it
is not your fault. For help, call:
National Domestic Violence Hotline
1-800 799-7233
TTY 1-800 787-3224
Sexual Assault Hotline
1-800 656-4673
Padres Amorosos,
Hijos Amorosos:
Loving Parents,
Loving Kids:
Creando Futuros Sin Violencia
Creating Futures without Violence
Creando hogares seguros
¿La relación que tengo es SALUDABLE?
Creating Safe Homes
Am I in a healthy relationship?
Your partner should help support you being a good parent and help
create a safe home for you and your children.
Su pareja debe apoyarle con el cuidado de los niños, y ayudar a crear un
ambiente seguro para usted y sus hijos.
4 Is my partner kind to me and respectful of my choices?
4 Does my partner help when the baby won’t stop crying?
4 Am I ever afraid of my partner (of being hurt, shamed)?
4 Am I ever afraid to leave my baby alone with my partner or boyfriend?
4 ¿Mi pareja es amable conmigo y respeta mis decisiones?
4 ¿Mi pareja me ayuda cuando el bebé no para de llorar?
4 ¿Le he tenido miedo a mi pareja (de que me lastime, o avergüence)?
4 ¿He tenido miedo de dejar al bebé solo con mi pareja o novio?
< FOLD
What About Your Childhood?
¿Qué pasó durante su infancia?
4 ¿Usted (o su pareja) vieron a su madre ser lastimada (golpeada)?
4 ¿Usted (o su pareja) experimentaron manoseos de tipo sexual por
parte de algún miembro de la familia?
4 ¿Usted (o su pareja) han sido lesionados o viven con el temor de
que algún miembro de la familia les haga daño?
Si contestó Sí a CUALQUIERA de estas preguntas, sepa que hay
ayuda disponible. Hablar con su visitador domiciliario o un amigo
acerca de estas experiencias puede ayudarle.
4 Did you (or your partner) see your mom hurt (beat up) by your
dad or her boyfriend?
4 Did you (or your partner) experience unwanted sexual touching by
someone in your family?
4 Did you (or your partner) have injuries or live in fear of being hurt
by someone in your family?
If you answered YES to ANY of these questions you are not alone.
Talking about these experiences with your home visitor or
a friend can help.
< FOLD
Criar a los hijos es un trabajo duro
Criar a los hijos después de haber sido lastimada por alguien que conoce y ama puede complicar aún más esta tarea.
Muchos padres que han sufrido abuso pueden perder el control con facilidad, enojarse
rápidamente, tener menos paciencia y sufrir más ansiedad.
Estas son respuestas aprendidas a lo que pasó en el pasado, sin embargo, hay estrategias que permiten mejorar la
situación:
Parenting is Hard Work
Parenting after being hurt by someone you know and love can make the work even harder.
Many parents who were abused can be ‘triggered’ easily, quick to
anger, have less patience and have more anxiety.
These are learned responses to what previously happened to you, but there are strategies
to make it better:
•
Encuentre a una persona de confianza a la que pueda llamar para darse un descanso si
se siente frustrada con su bebé, y llame a su visitador domiciliario para conseguir apoyo.
•
•
Si no se siente segura de la capacidad de su pareja para controlar su frustración con el
bebé, debe evitar dejarlo solo con esta persona.
•
•
Si se siente frustrada, ponga al bebé suavemente en la cuna mientras se calma en el cuarto
de al lado.
•
< FOLD
¿Mis niños están resultando afectados?
If you feel frustrated, gently place the baby in the crib while you
catch your breath in the next room.
If you feel unsure about your partner’s ability to handle their
frustration with the baby, don’t leave the baby alone with them.
Find a safe person that you can call to take a break if you are
frustrated with your baby and call your home visitor for support.
How Are My Children Affected?
2. Ask your home visitor or pediatrician about programs to help
children exposed to violence.
3. Stay connected to your children and listen to them. Your
relationship with them is the most important thing to keep
them on track.
2. Pregúntele a su visitador domiciliario o pediatra si hay
programas para ayudar a niños expuestos a situaciones de
violencia.
3. Manténgase conectada con sus hijos, y escúchelos. Su
relación con ellos es el punto más importante para
mantenerlos en buen camino.
1. Let them know that what has happened is not their fault.
1. Déjeles saber que lo que ha pasado no es culpa de ellos.
Here are ways to help your children:
Estas son algunas maneras en que puede ayudar a sus hijos:
Children who live in homes where their mother has been hurt or
experience harsh punishment are more likely to have learning and
behavior problems. Getting help for you is a great first step for them.
Los niños que viven en hogares en los que la madre ha sido lastimada o en los
que se aplican castigos severos son más propensos a tener problemas de
aprendizaje y de comportamiento. Conseguir ayuda para usted misma es un
buen primer paso para ellos.
Appendix H
Appendix I
BIRTH CONTROL EDUCATION
Methods that clients can use without their partners’ knowledge
WHAT IS IT?
HOW DOES IT WORK?
HELPFUL HINTS
RISKS OF DETECTION
Implanon might be detected if palpated.
The IUD has a string that hangs out the
cervical opening. If a woman is worried
about her partner finding out that she is
using birth control, she can ask the provider to snip the strings off at the cervix (in
the cervical canal) so her partner can’t feel
them or pull it out of her.
Unlike previous implantable
methods (Norplant), is generally
invisible to the naked eye and
scarring is rare.
Mirena has a small amount of
hormone that is released that
can lessen cramping around the
time of your period and make
the bleeding less heavy.
Periods may stop completely. This may
be a less safe option if her partner closely
monitors menstrual cycles.
Periods may stop completely. This may
be a less safe option if her partner closely
monitors menstrual cycles.
3 months
Once administered, there is no
way to stop the effects of the
shot.
Clients can remove the pills from the
packaging so that partners will not know
what they are.
Mirena: 5 years
Single dose—must
be taken after
every instance of
unprotected sex.
Clients can get emergency
contraction to keep on hand
before unprotected sex occurs.
EC is NOT abortion—just like
“regular” birth control pills, it
prevents ovulation.
ParaGuard: 12
years
3 years
HOW LONG IS IT
EFFECTIVE?
All of these methods (except Emergency Contraception which can be purchased over the counter at a pharmacy by men or women 17 or older) must be
prescribed by a doctor or nurse practitioner. Clients can call 1-800-230-PLAN to find a health care provider near them who can prescribe birth control. Talk
to your client about safety planning around doctor’s office reminder calls, and scheduling visits—if making appointments for birth control may put them
at risk with a partner.
Implanon
A matchstick-sized tube of hormones (the same ones that are in
birth control pills) are inserted in
your inner arm .
Intrauterine Device
(IUD)- Mirena &
ParaGuard
Depo-Provera (“the
birth control shot”)
Depo-Provera is a shot that provides hormones—the same ones
that are in birth control pills—that
prevent a woman from ovulating.
The small T-shaped device, which
prevents pregnancy by changing
the lining of your uterus so an egg
cannot implant, is inserted into
your uterus.
Emergency Contraception (EC)
Either a single dose or series
of hormones are given within
72-hours of unprotected sex to
prevent pregnancy.
This is also referred to
as the “Morning After
Pill”
SECONDARY TRAUMA
Common Reactions to Caring for Survivors of Trauma
Helplessness
•
•
•
•
Depressive symptoms
Feeling ineffective with patients [clients]
Reacting negatively to patients [clients]
Thinking of quitting clinical [contact with clients] work
Appendix J
Fear
•
•
•
•
•
Recurrent thoughts of threatening situations
Chronic suspicion of others
Sleep disruptions
Physical symptoms
Inability to relax or enjoy pleasurable activities
Anger
• Reacting angrily to patients [clients] /staff, colleagues
• Feelings of guilt
• Decreased self-esteem
Detachment
•
•
•
•
•
Avoiding patients
Avoiding emotional topics during patient encounters
Ignoring clues from patients [clients] about trauma
Failing to fulfill social or professional roles
Chronic lateness
Boundary Violation and Transference
•
•
•
•
•
Taking excessive responsibility for the patient [client]
Seeing patient [client] after hours
Doing something out of usual practice patterns
Sharing own problems with patient [client]
Patient [client] trying to care for service provider
Use of Alcohol and Drugs
• Increased use of alcohol
• Initiation or use of drugs
• Misuse of prescription medication
Source: Intimate Partner Violence, 2009 edited by Connie Mitchell and Deidre Anglin, Oxford Press
POST-TRAINING SURVEY
FOR HOME VISITORS
Thank you for providing feedback to us. The following refers to your home visitation clients, meaning
the adult caregivers/parents caring for an infant/child.
The training today increased my understanding of:
1) How to discuss confidentiality with my home visitation clients before assessing for domestic
violence (DV) or coercion
A. Strongly Disagree B. Disagree
C. Neutral
D. Agree
E. Strongly Agree
2) What local & national resources are available to assist my clients around domestic violence (DV)
and childhood violence (including witnessing domestic violence, childhood abuse)
C. Neutral
D. Agree
E. Strongly Agree
3) How to assess for domestic violence (DV) among my clients
C. Neutral
D. Agree
E. Strongly Agree
4) How to assess for reproductive coercion among my clients
C. Neutral
D. Agree
E. Strongly Agree
5) How to assess for domestic violence (DV) and childhood violence when clients are depressed
or using substances
C. Neutral
D. Agree
E. Strongly Agree
6) How to discuss birth control that is less vulnerable to partner interference
C. Neutral
D. Agree
E. Strongly Agree
7) How to discuss safety planning with a client who discloses an abusive relationship
C. Neutral
D. Agree
E. Strongly Agree
8) How to discuss a client’s experience with violence in their childhood and the possible effect on
their parenting
C. Neutral
D. Agree
E. Strongly Agree
Following the training today, I am more likely to:
9) Discuss the limits of confidentiality with my clients before asking about coercion or violence
C. Neutral
1
D. Agree
E. Strongly Agree
Appendix K
Post-Training Survey for Home Visitors
10)Assess for domestic violence (DV) with all my clients
C. Neutral
D. Agree
E. Strongly Agree
11)Assess for childhood experiences of violence (CEV) with all my clients
C. Neutral
D. Agree
E. Strongly Agree
12)Assess for DV and CEV with any client who has a mental health or substance abuse issue
C. Neutral
D. Agree
E. Strongly Agree
13)Provide information about DV/CEV to all my home visitation clients
C. Neutral
D. Agree
E. Strongly Agree
Please circle at least one action item that you intend to do
differently following the training today:
A) Make safety cards related to DV/CEV and healthy parenting available to all home visitation
clients
B) Offer an in-service training for all home visitation staff on DV/CEV
Appendix K
C) Set up a home visitation protocol for assessing for DV/CEV with home visits
D) Other (please be as specific as you can): ____________________________________________
______________________________________________________________________________
______________________________________________________________________________
What support do you need to incorporate discussion of domestic violence (DV) and childhood
exposure to violence (CEV) in all your home visitation encounters? __________________________
__________________________________________________________________________________
__________________________________________________________________________________
_________________________________________________________________________
Additional Comments: ______________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Thank you for your time!
2
BIBLIOGRAPHY
Module 1: Introduction and Workshop Guidelines
REFERENCES:
Dutton M. Empowering and Healing the Battered Woman. 1992. Springer, New York, NY
Eckenrode J, Ganzel B, Henderson C, Smith E, Olds D, Powers J, Cole R, Kitzman H, Sidora K. (2000) Preventing
Child Abuse and Neglect with a Program of Nurse Home Visitation: The Limiting Effects of Domestic Violence.
Journal of the American Medical Association. 284(11): 1385-1391.
Eddy T, Kilburn E, Chang C, Bullock L, Sharps P. Facilitators and Barriers for Implementing Home Visit Interventions to Address Intimate Partner Violence: Town and Gown Partnerships. Nursing Clinics of North America.
2008;43:419-435.
Evanson, TA. Addressing Domestic Violence Through Maternal-Child Health Home Visiting: What We Do and
Do Not Know. Journal of Community Health Nursing. 2006,;23(2):95-111.
Landenburger, Campbell, & Rodriquez, 2004 [Textbook: Family Violence and Nursing Practice, J. Humphreys &
J. Campbell, Eds]
March of Dimes. Abuse During Pregnancy: A Protocol for Prevention and Intervention, 3rd Edition. 2007.
White Plains, NY. www.marchofdimes.com/nursing
McCloskey LA, Lichter E, Williams C, Gerber M, Wittenberg E, Ganz M. Assessing Intimate Partner Violence in
Health Care Settings Leads to Women’s Receipt of Interventions and Improved Health. Public Health Reporter.
2006;121(4):435-444.
McFarlane J, Malecha A, Gist J, Watson K, Batten E, Hall I, Smith S. An intervention to increase safety behaviors
of abused women: results of a randomized clinical trial. Nursing Research. 2002;51:347-354.
McFarlane J, Malecha A, Gist J, Watson K, Batten E, Hall I, Smith S. A nursing intervention to increase safety behaviors of abused women that remains effective for 18months. American Journal of Nursing. 2004;104(3):40-50.
Olds DL, Robinson J, Pettitt L, Luckey DW, Holmberg J, Ng RK, Isacks K, Sheff K, Henderson CR. Effects of
Home Visits by Paraprofessionals and by Nurses: Age 4 Follow-up Results of a Randomized Trial. Pediatrics.
2004;114(6):1560-1568.
Parker B, McFarlane J, Soeken K, Sliva C, Reel S. Testing an intervention to prevent further abuse to pregnant
women. Research in Nursing and Health. 1999;22:59-66.
Module 2: Overview of Domestic Violence:
Definitions and Dynamics
REFERENCES:
Black MC, Breiding MJ, National Center for Injury Prevention and Control, CDC. Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence---United States, 2005. MMWR.
2008;57(05):113-117.
Mitchell SJ, See HM, Tarkow AKH, Cabrera N. Conducting Studies with Fathers: Challenges and Opportunities
Applied Development Science 2007, Vol. 11, No. 4, 239-244.
Bibliography
Sharps PW, Campbell J, Baty ML, Walker KS, and Bair MH. Merritt Current Evidence on Perinatal Home Visiting
and Intimate Partner Violence. J Obstet Gynecol Neonatal Nurs. 2008; 37 (4): 480-491.
Tjaden P, Thoennes N. Extent, Nature, and Consequences of Intimate Partner Violence. U.S. Department of
Justice, Offices of Justice Programs, National Institute of Justice. Washington, DC. July, 2000.
Module 3: Assessment and Safety Planning for Domestic
Violence in Home Visitation
REFERENCES:
AMA: Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Health literacy: report of the
Council on Scientific Affairs. JAMA. 1999;281: 552-557.
Baker L, Cunningham A, Helping an Abused Woman: 101 Things to Know, Say and Do. 2008. www.lfcc.on.ca
Renker, P and Tonkin, P. (2006) Women’s views of confidentiality issues related to and acceptability of prenatal
violence screening. Obstetrics and Gynecology, V.107 N.2, February, 2006: 348-354
Module 4: Impact of Domestic Violence on
Perinatal Health Outcomes
REFERENCES:
Amaro H, Fried LE, Cabral H. Zuckerman B. Violence During Pregnancy and Substance Use. American Journal of
Public Health. 1990;80(5):575-579.
Bailey BA, Daugherty RA. Intimate Partner Violence During Pregnancy: Incidence and Associated Health Problems in a Rural Population. Maternal and Child Health Journal. 2007;11(5):495-503.
Berenson AB, Wiemann CM, Wilkinson GS, Jones WA, Anderson GD. Perinatal Morbidity Associated with Violence Experienced by Pregnant Women. American Journal of Obstetrics and Gynecology. 1994;170:1760-1769.
Blabey MH, Locke ER, Goldsmith YW, Perham-Hester KA. Experience of a Controlling or Threatening Partner Among Mothers with Persistent Symptoms of Depression American Journal of Obstetrics & Gynecology.
2009;201:173.e1-9.
Bullock LFC, Mears JLC, Woodcock C, Record R. Retrospective Study of the Association of Stress and Smoking
During Pregnancy in Rural Women. Addictive Behaviors. 2001;26:405-413.
Campbell JC, Poland ML, Waller JB, Ager J. Correlates of Battering During Pregnancy. Research in Nursing and
Health. 1992;15:219-226.
Chang J, Berg CJ, Saltzman LE, Herndon J. Homicide: A Leading Cause of Injury Deaths Among Pregnancy and
Postpartum Women in the United States, 1991-1999. American Journal of Public Health. 2005;95(3):471-477.
Coker AL, Smith PH, Thompson MP, McKeown RE, Bethea L, Davis KE. Social Support Protects Against the
Negative Effects of Partner Violence on Mental Health. Journal of Women’s Health & Gender-Based Medicine.
2002;11(5):465-476.
Curry MA. The Interrelationships Between Abuse, Substance Use, and Psychosocial Stress During Pregnancy.
JOGNN. 1998;27(6):692-699.
Bibliography
Lipsky S, Holt VL, Esterling TR, Critchlow C. Police-Reported Intimate Partner Violence During Pregnancy and
Risk of Antenatal Hospitalization. Maternal and Child Health Journal. 2004;8(2):55-63.
Martin SL, Beaumont JL, Kupper LL. Substance Use Before and During Pregnancy: Links to Intimate Partner Violence. American Journal of Drug and Alcohol Abuse. 2003;29:599-617.
Martin SL, Kilgallen B, Dee DL, Dawson S, Campbell JC. Women in Prenatal Care/Substance Abuse Treatment
Programme: Links between Domestic Violence and Mental Health. Journal of Maternal and Child Health.
1998;2:85-94.
McFarlane J, Parker B, Soeken K. Physical Abuse, Smoking and Substance Abuse During Pregnancy: Prevalence, Interrelationships and Effects on Birth Weight. Journal of Obstetrics, Gynecology and Neonatal Nursing.
1996;25:313-20.
Moraes CL, Amorim AR, Reichenheim ME. Gestational Weight Gain Differentials in the Presence of Intimate
Partner Violence. International Journal of Gynaecology and Obstetrics. 2006;95:254-260.
Perham-Hester KA, Gessner BD. Correlates of Drinking During the Third Trimester of Pregnancy in Alaska. Maternal and Child Health Journal. 1997;1(3): 165-172.
Silverman JG, Decker MR, Reed E, Raj A. Intimate Partner Violence Victimization Prior to and During Pregnancy
Among Women Residing in 26 U.S. States: Associations with Maternal and Neonatal Health. American Journal
of Obstetrics and Gynecology. 2006;195:140-148.
Module 5: Making the Connection: Domestic and Sexual Violence,
Birth Control Sabotage, Pregnancy Pressure, and Unintended Pregnancies
REFERENCES:
Campbell J, Pugh LD, Campbell D, Visscher M. The Influence of Abuse on Pregnancy Intention. Women’s Health
Issues. 1995;5:214-223.
Coggins M, Bullock LF. The Wavering Line in the Sand: the Effects of Domestic Violence and Sexual Coercion.
Issues in Mental Health Nursing. 2003:24(6-7):723-738.
Decker MR, Silverman JG, Raj A. Dating Violence and Sexually Transmitted Disease/HIV Testing and Diagnosis
among Adolescent Females. Pediatrics. 2005;116(2):e272-276.
Fanslow J, Whitehead A, Silva M, Robinson E. Contraceptive Use and Associations with Intimate Partner
Among a Population-based Sample of New Zealand Women. Australian & New Zealand Journal of Obstetrics &
Gynaecology. 2008;48(1):83-89.
Goodwin MM, Gazmararian JA, Johnson CH, et al. Pregnancy Intendedness and physical abuse around the time
of pregnancy: Findings form the pregnancy risk assessment monitoring system, 1996-1997. PRAMS Working
Group. Pregnancy Risk Assessment Monitoring System. Maternal and Child Health Journal. 2000;4(2):85-92.
Lang DL, Salazar LF, Wingood GM, DiClemente RJ, Mikhail I. Associations Between Recent Gender-based Violence and Pregnancy, Sexually Transmitted Infections, Condom Use Practices, and Negotiation of Sexual Practices Among HIV-Positive Women. Journal of Acquired Immune Deficiency Syndromes. 2007;46(2):216-221.
Miller E, Decker MR, Reed E, Raj A, Hathaway JE, Silverman JG. Male Partner Pregnancy-Promoting Behaviors
and Adolescent Partner Violence: Findings From a Qualitative Study with Adolescent Females. Ambulatory
Pediatrics. 2007;7(5):360-366.
Raneri LG, Wiemann CM. Social Ecological Predictors of Repeat Adolescent Pregnancy. Perspectives on Sexual
and Reproductive Health. 2007;39(1):39-47.
Bibliography
Raphael J. Teens Having Babies: The Unexplored Role of Domestic Violence. The Prevention Researcher.
2005;12(1):15-17.
Roberts TA, Auinger P, Klein JD. Intimate Partner Violence and the Reproductive Health of Sexually Active Girls.
Journal of Adolescent Health. 2005;36(5):380-385.
Sakar NN. The Impact of Intimate Partner Violence on Women’s Reproductive Health and Pregnancy Outcome.
Journal of Obstetrics and Gynaecology. 2008;28(3):266-271.
Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. JAMA.
2001;286(5)572-579.
Wingood GM, DiClemente R. The effects of an Abusive Primary Partner on the Condom Use and Sexual Negotiation Practices of African-American Women. Journal of Public Health. 1997;87:1016-1018.
Module 6: The Effects of Domestic Violence on Children
REFERENCES:
Campbell JC, Lewandowski LA. Mental and Physical Health Effects of Intimate Partner Violence on Women and
Children. Psychiatric Clinics of North America. 1997;20(2):353-374.
Edelson J. Children’s Witnessing of Adult Domestic Violence. Journal of Interpersonal Violence. 1999;14:839-870.
Graham-Bermann SA, Seng J. Violence Exposure and Traumatic Stress Symptoms as Additional Predictors of
Health Problems in High-risk Children. Journal of Pediatrics. 2005;146(3):349-354.
Hurt H, Malmud E, Brodsky NL, Giannetta J. Exposure to Violence: Psychological and Academic Correlates in
Child Witnesses. Archives of Pediatric Adolescent Medicine. 2001;155:1351-1356.
Kernic MA, Holt VL, Wolf ME, McKnight B, Hueber CE, Rivara FP. Academic and School Health Issues Among
Children Exposed to Maternal Intimate Partner Abuse. Archives of Pediatric and Adolescent Medicine.
2002;156:549-555.
Lehmann P. Posttraumatic Stress Disorder (PTSD) and Child Witnesses to Mother-Assault: A Summary and
Review. Children and Youth Services Review. 2000;22(3/4):275-306.
McCloskey LA, Walker M. Posttraumatic Stress in Children Exposed to Family Violence and Single-Event Trauma.
Journal of the American Academy of Child and Adolescent Psychiatry. 2000;39:108-115.
Pfouts J, Schopler J, Henley H. Forgotten Victims of Family Violence. Social Work. 1982; July:367-368.
Spaccarelli S, Sandler IN, Roosa M. History of Spouse Violence Against Mother: Correlated Risks and Unique
Effects in Child Mental Health. Journal of Family Violence. 1994;9(1):79-98.
Wilden SR, Williamson WD, Wilson GS. Children of Battered Women: Developmental and Learning Profiles.
Clinical Pediatrics. 1991;30:299-304.
Wolfe DA, Crooks CV, Lee V, McIntyre-Smith A, Jaffe PG. The Effects of Children’s Exposure to Domestic Violence: A Meta-Analysis and Critique. Clinical Child and Family Psychology Review. 2003; 6(3):171-187.
Bibliography
Module 7: Impact of Domestic Violence on Mothering:
Helping Moms Promote Resiliency for Children
REFERENCES:
Baker L, Cunningham A. Helping Children Thrive: Supporting Women Abuse Survivors as Mothers. 2004.
www.lfcc.on.ca
Bancroft L, Silverman J. The Batterer as Parent. 2002. Sage Publications, Thousand Oaks, California.
Dubowitz H, Black MM, Kerr MA, Hussey JM, Morrel TM, Everson MD, Starr RH. Type and Timing of Mothers’
Victimization: Effects on Mothers and Children. Pediatrics. 2001;107(4):728-735.
Edleson JL, Mbilinyi LF, Shetty, S. Parenting in the context of domestic violence. San Francisco, CA. 2003; Judicial Council of California.
Holden GW, Ritchie KL. Linking extreme marital discord, child rearing, and child behavior problems:evidence
from battered women. 1991;62(2):311-327.
Holden, Stein, Ritchie, Harris, Jouriles. 1998 Children exposed to maritial violence: Theory, research and applied issues, 289-334.
Levendosky AA, Huth-Bocks AC, Shapir DL, Semel MA. (2003). The impact of domestic violence on the maternal-child relationship and preschool-age children’s functioning. Journal of Family Psychology, 17, 275-287.
McDonald R, Jouriles EN, Skopp NA. Reducing Conduct Problems Among Children Brought to Women’s
Shelters: Intervention Effects 24 Months Following Termination of Services. Journal of Family Psychology.
2006;20(1):127-136.
McGuigan WM, Pratt CC. The predictive impact of domestic violence on three types of child maltreatment.
Child Abuse & Neglect. 2001;25:869-883.
Pennsylvania Coalition Against Domestic Violence . A Kid is So Special (KISS). 2008. www.pcadv.org
Quinlivan JA, Evans SF. Impact of Domestic Violence and Drug Abuse in Pregnancy on Maternal Attachment
and Infant Temperament in Teenage Mothers in the Setting of Best Clinical Practice. Archives of Women’s
Mental Health. 2005;8:191-199.
Rumm PD, Cummings P, Krauss MR, Bell MA, Rivara FP. Identified spouse abuse as a risk factor for child abuse.
Child Abuse and Neglect. 2000;24(11):1375-1381.
Module 8: Childhood Exposure to Domestic Violence
and Its Impact on Parenting
REFERENCES:
Higgins, Gina O’Connell (1994) Resilient Adults: Overcoming a Cruel Past (San Francisco: Jossey-Bass)
Kaufman, J., and E. Zigler, 1987, “Do Abused Children become Abusive Parents?” American Journal of Orthopsychiatry 57(2): 186-192
Kaufman, J., and E. Zigler, 1993, “The Intergenerational Transmission of Abuse is Overstated.” In Current Controversies in Family Violence. Edited by R. J Gelles and D. R. Loseke, Newbury Park, CA: Sage Publications.
Bibliography
Steele, Brandt F. (1997), “Further Reflections on the Therapy of Those Who Mistreat Children,” in Mary Edna
Helfer, Ruth S. Kempe, and Richard Kempe, and Richard D. Krugman, eds., The Battered Child, 5th addition (Chicago: University of Chicago Press), Chapter 26.
Module 9: Fathering After Violence
REFERENCES:
Bent-Goodley TB. Health Disparites and Violence Against Women Why and How Cultural and Societal Influences Matter. Trauma Violence Abuse. April 2007 vol. 8 no. 2 90-104.
Dovovan RJ, Paterson D, Francas M. Targeting male perpetrators of intimate partner violence: Western Australia’s “Freedom from Fear” campaign. Social Marketing Quarterly. 1999;5(3):128-144.
Dubowitz H, Black MM, Kerr MA, Hussey JM, Morrel TM, Everson MD, Starr RH. Type and Timing of Mothers’
Victimization: Effects on Mothers and Children. Pediatrics. 2001;107(4):728-735.
Silverman JG, Williamson GM. Social ecology and entitlements involved in battering by heterosexual college
males: contributions of family and peers. Violence and Victims. 1997;12(2):147-165.
Module 10: Preparing Your Program and Supporting
Staff Exposed to Violence and Trauma
REFERENCES:
Chamberlain L. Addressing Domestic Violence within the Context of Home Visitation. Journal of Emotional
Abuse. 2008; 8:205-216.
Journal of Emotional Abuse, Volume 8 (1/2): 2008; available online at http://jea.haworthpress.com
Module 11: Mandated Reporting for Child Abuse:
Challenges and Considerations
(No references for this module)
Module 12: Closing and Post-training Survey
(No references for this module)
Our vision is now our name.
100 Montgomery Street, The Presidio
San Francisco, CA 94129
Phone 415.678.5500
TTY 800.595.4889
©2011 Futures Without Violence. All rights reserved.

Healthy Moms, Happy Babies

Transcription

Similar documents

DVSN Brochure - The Bedford Citizen

A NEW DAY Brochure Women - The Tree of Peace Friendship Centre

Abuse in close relationships - Upplands

Tanisha M. Bagley - printhouse books

Russell Simmons, NYC Councilmen and Erica Ford announce New

here - Legal Services of the Hudson Valley

Combatting Gender-related Violence

Slajd 1 - Niebieska Linia

Lessons from Pippi Longstocking: Imagining Childrens` Responses

Online Presentation Gen Next 2 0